Information Collection

OMBuds Referral Form and Satisfaction Survey

IC 241386 under ICR 201701-1225-001 · OMB 1225-0088.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0088 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Ombuds Service Eva Ombuds Referral Form and Satisfaction Survey	Form and Instruction
Ombuds Service Eva Ombuds Service Evaluation Form Ombuds Service Evaluation Form.docx	Form and Instruction
Ombuds Service Ref Ombuds Service Referral Form Ombuds Service Referral Form.docx	Form and Instruction
Ombuds Referral and Evaluation Forms Fast Track.docx Ombuds Referral and Evaluation Forms Fast Track	IC Document

IC Title:

Ombuds Referral Form and Satisfaction 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
Form and Instruction	Ombuds Service Evaluation Form	Ombuds Service Evaluation Form	Ombuds Service Evaluation Form.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Ombuds Service Referral Form	Ombuds Service Referral Form	Ombuds Service Referral Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	100	100
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Ombuds Referral and Evaluation Forms Fast Track	Ombuds Referral and Evaluation Forms Fast Track.docx	04/17/2020

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