Rockledge 1 and 2 Furniture Mockup Feedback

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⚠️ Notice: This information collection may be referencing outdated material.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 0925-0642 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Rockledge 1 and 2 Furniture Mockup Feedback Form and Instruction
1 Mockup Furniture Survey Card 040418-PRA-RKL 1-2 Mockup Furniture Survey Card-updated.pptx Form and Instruction
032918-PRA-Request-RKL 1-2 Mockup Survey-OMB Form_RockI-II.docx RKL 1-2 Mockup Survey OMB Form IC Document

Information Collection (IC) Details

IC Title:	Rockledge 1 and 2 Furniture Mockup Feedback	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	1	Mockup Furniture Survey Card	040418-PRA-RKL 1-2 Mockup Furniture Survey Card-updated.pptx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
RKL 1-2 Mockup Survey OMB Form	032918-PRA-Request-RKL 1-2 Mockup Survey-OMB Form_RockI-II.docx	04/04/2018

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