Information Collection

Experimental Sites Initiative (ESI) Experiment #5 Survey

IC 222479 under ICR 201510-1845-012 · OMB 1845-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1845-0045 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Experiment 5 survey FINAL.doc	Other-Survey
Template for Generic Customer Surveys - Experiment 5 FINAL rev.doc Generic Template	IC Document

IC Title:

Experimental Sites Initiative (ESI) Experiment #5 Survey

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
Other-Survey			Experiment 5 survey FINAL.doc		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	12	12
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Template	Template for Generic Customer Surveys - Experiment 5 FINAL rev.doc	07/14/2016

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