Beneficiaries

OMHA Annual Appellant Climate Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0330 can be found here:

Documents and Forms

Document Name Document Type
Appendix C1. Introductory Letter-English.docx Other-letter
Appendix C2. Introductory Letter-Spanish.docx Other-letter
Appendix C3 Telephone Survey Introduction Script (English).docx Other-survey
Appendix C5 Reminder Voicemail Script (English).docx Other-script
Appendix C6 Reminder Voicemail Script (Spanish).docx Other-script
Appendix C4 Telephone Survey Introduction Script (Spanish).docx Other-script
Appendix C7. Reminder Letter with Mail Survey (English).docx Other-survey
Appendix C8. Reminder Letter with Mail Survey (Spanish).docx Other-survey
60-dayFederal Register, Volume 82 Issue 187 (Thursday, September 28, 2017).htm 60-day IC Document
30-day Federal Register, Volume 82 Issue 247 (Wednesday, December 27, 2017).htm 30day IC Document

Information Collection (IC) Details

IC Title:	Beneficiaries	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-letter	Appendix C1. Introductory Letter-English.docx	No	Paper Only
Other-letter	Appendix C2. Introductory Letter-Spanish.docx	No	Paper Only
Other-survey	Appendix C3 Telephone Survey Introduction Script (English).docx	No	Paper Only
Other-script	Appendix C5 Reminder Voicemail Script (English).docx	No	Paper Only
Other-script	Appendix C6 Reminder Voicemail Script (Spanish).docx	No	Paper Only
Other-script	Appendix C4 Telephone Survey Introduction Script (Spanish).docx	No	Paper Only
Other-survey	Appendix C7. Reminder Letter with Mail Survey (English).docx	No	Fillable Fileable
Other-survey	Appendix C8. Reminder Letter with Mail Survey (Spanish).docx	No	Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	200	40	160
Annual IC Time Burden (Hours)	50	21	29
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
60-day	60-dayFederal Register, Volume 82 Issue 187 (Thursday, September 28, 2017).htm	01/26/2018
30day	30-day Federal Register, Volume 82 Issue 247 (Wednesday, December 27, 2017).htm	01/26/2018

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