OMBuds Referral Form and Satisfaction Survey

Department of Labor 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⚠️ Notice: This information collection may be referencing outdated material.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 1225-0088 can be found here:

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Ombuds Referral Form and 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 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 %

	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

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.