American Community Survey Customer Feedback Form

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⚠️ Notice: This information collection may be referencing outdated material.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 0690-0030 can be found here:

Documents and Forms

Document Name Document Type
Form Form American Community Survey Customer Feedback Form Form
Form ACS Feedback Form FeedbackFormScreenShot.pdf Form
Survey ACS Data or User Survey DataOrSurveyUser_revised.pdf Form
Generic Clearance for the Collection of Routine Customer Feedback Template-ACS 2017.docx Customer Feedback Fast Track Template IC Document

Information Collection (IC) Details

IC Title:	American Community Survey Customer Feedback Form	Agency IC Tracking Number:	Census

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	Form	ACS Feedback Form	FeedbackFormScreenShot.pdf		Yes	Yes	Fillable Fileable
Form	Survey	ACS Data or User Survey	DataOrSurveyUser_revised.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	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	1,200	1,200
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Customer Feedback Fast Track Template	Generic Clearance for the Collection of Routine Customer Feedback Template-ACS 2017.docx	12/13/2017

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