Center for States Media Consumption Survey

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Center for States Media Consumption Survey Form and Instruction
1 Media Consumption Survey Instrument Media Consumption Survey Instrument for OMB_020416 (2).docx Form and Instruction
OMB Fast Track App Center for States Media Consumption Survey 2-4-16-For OMB (2).doc Center for States Media Consumption Survey IC Document

Information Collection (IC) Details

IC Title:	Center for States Media Consumption Survey	Agency IC Tracking Number:

IC Status: Unchanged

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	Media Consumption Survey Instrument	Media Consumption Survey Instrument for OMB_020416 (2).docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Center for States Media Consumption Survey	OMB Fast Track App Center for States Media Consumption Survey 2-4-16-For OMB (2).doc	02/08/2016

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