Online Registration Fom

Online Registration Form.docx

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

Online Registration Fom

OMB: 3206-0257

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OMB Control No: 3206-0257


REGISTRATION FORM

Please share some basic information with us so we can process your registration.

First Name: *
Shape1  

Middle Initial:
Shape2

Last Name: *

Shape3  

Parent Agency/Organization:
Shape4

Subagency/Division:
Shape5  

Dept/Agency Mailing Address: *
Shape6  

Floor/Suite/Mailstop:
Shape7

City: *
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State: *
Shape9  

Zip Code: *
Shape10  Invalid Zip Code format – should be either 12345 or 12345-6789.


Job Title: *
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E-mail:

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Work Phone (Format "XXX-XXX-XXXX" plus optional extension): *
Shape13   Work Phone must be in the format: XXX-XXX-XXXX (plus optional extension).




What are you hoping to gain from these sessions?

Shape14

(*Required Field)

PRIVACY STATEMENT

This information is solicited under the authority of 5 U.S.C. §§ 4115–4118. The primary uses of this information are by the Office of Personnel Management (OPM) to register registrants for the various seminars provided at OPM training facilities. OPM may use the information for studies and statistics that will not identify you. The information may be disclosed to appropriate Federal, State, or local agencies when relevant to civil, criminal, or regulatory investigations or prosecutions; in judicial or administrative proceedings; to congressional offices; and to Federal agencies for employment or security reasons.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorRichman, Kevin
File Modified0000-00-00
File Created2021-01-24

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