Information Collection

Federal Feedback Button - Dept. of State

IC 217150 under ICR 201504-1405-004 · OMB 1405-0193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0193 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SV-2015-0007 Federal Feedback Button - Dept. of State	Form
SV-2015-0007 State Kiosk Survey State Kiosk Survey (6-2015).jpg	Form
State Kiosk sign with OMB-PRA (attached to Kiosk) 6-2015.pdf Signage for Kiosk	IC Document
Generic Clearance Submission Template State Kiosk Survey (6-2015).pdf Generic Clearance Submission Template	IC Document

IC Title:

Federal Feedback Button - Dept. of State

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SV-2015-0007	State Kiosk Survey	State Kiosk Survey (6-2015).jpg		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 76,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	76,000	76,000
Annual IC Time Burden (Hours)	215	215
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Signage for Kiosk	State Kiosk sign with OMB-PRA (attached to Kiosk) 6-2015.pdf	06/22/2015
Generic Clearance Submission Template	Generic Clearance Submission Template State Kiosk Survey (6-2015).pdf	06/22/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.