NCI OFSM Shuttle Special Service

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⚠️ Notice: This information collection may be referencing outdated material.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 NCI OFSM Shuttle Special Service Form
1 Shuttle Special Shuttle Special Survey.pdf Form
Fast Track Template -Shuttle Survey.doc fast track template Shuttle Survey IC Document

Information Collection (IC) Details

IC Title:	NCI OFSM Shuttle Special Service	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	1	Shuttle Special	Shuttle Special Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	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	1,500	1,500
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
fast track template Shuttle Survey	Fast Track Template -Shuttle Survey.doc	05/02/2018

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