DisasterAssistance.gov Customer Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1660-0130 can be found here:

Documents and Forms

Document Name Document Type
Form FEMA Form 519-0-17 DisasterAssistance.gov Customer Satisfaction Survey Form
FEMA Form 519-0-17 Registration Intake (RI) DisasterAssistance.gov Customer FEMA Form 519-0-17, DisasterAssistance gov-Survey-RI Questions.pdf www.surveymonkey.com/r/RI2016 Form
FEMA Form 519-0-17 General DisasterAssistance.gov Customer Satisfaction Sur FEMA Form 519-0-17, DisasterAssistance gov-Survey-GeneralQuestions.pdf www.surveymonkey.com/r/general2016 Form
FEMA Form 519-0-17 Applicant Inquiry (AI) DisasterAssistance.gov Customer S FEMA Form 519-0-17, DisasterAssistance gov-Survey-AI Questions.pdf www.surveymonkey.com/r/AI2016 Form
DisasterAssistance gov-Generic Clearance Application_FINAL_020416.pdf Signed Generic Clearance Application IC Document

Information Collection (IC) Details

IC Title:	DisasterAssistance.gov Customer Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FEMA Form 519-0-17	Registration Intake (RI) DisasterAssistance.gov Customer Satisfaction Survey	FEMA Form 519-0-17, DisasterAssistance gov-Survey-RI Questions.pdf	https://www.surveymonkey.com/r/RI2016	Yes	Yes	Fillable Printable
Form	FEMA Form 519-0-17	General DisasterAssistance.gov Customer Satisfaction Survey	FEMA Form 519-0-17, DisasterAssistance gov-Survey-GeneralQuestions.pdf	https://www.surveymonkey.com/r/general2016	Yes	Yes	Fillable Printable
Form	FEMA Form 519-0-17	Applicant Inquiry (AI) DisasterAssistance.gov Customer Satisfaction Survey	FEMA Form 519-0-17, DisasterAssistance gov-Survey-AI Questions.pdf	https://www.surveymonkey.com/r/AI2016	Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	875	875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Signed Generic Clearance Application	DisasterAssistance gov-Generic Clearance Application_FINAL_020416.pdf	03/03/2016

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