Health and Safety Fair Customer Feedback Survey_2018

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⚠️ Notice: This information collection may be referencing outdated material.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 2700-0153 can be found here:

Documents and Forms

Document Name Document Type
H_and_S_Fair_Survey[5].PNG Other-Survey screenshot
Survey Questions for Safety Health Fair 2018_updated.docx Other-Survey script
Health and Safety Fair Survey Fast Track Short Form 2018_FINAL_1.doc Health and Safety Fair Survey Fast Track Short Form 2018 IC Document

Information Collection (IC) Details

IC Title:	Health and Safety Fair Customer Feedback Survey_2018	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
Other-Survey screenshot			H_and_S_Fair_Survey[5].PNG		Yes	Yes	Fillable Fileable
Other-Survey script			Survey Questions for Safety Health Fair 2018_updated.docx		Yes	Yes	Fillable Fileable

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Health and Safety Fair Survey Fast Track Short Form 2018	Health and Safety Fair Survey Fast Track Short Form 2018_FINAL_1.doc	07/13/2018

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