Community Pulse Check (CPC) Digital Comment Card

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Document Name Document Type
Form 001 Community Pulse Check (CPC) Digital Comment Card Form
001 CPC_SurveyWireframe2_v2_withNewQuestion_061719 CPC_SurveyWireframe2_v2_withNewQuestion_061719.pdf Form
001 CPC_SurveyWireframe2_v2_07162019.pdf CPC_SurveyWireframe2_v2_07162019.pdf Form
CPC_FastTrackClearance_06.24.19.docx Community Pulse Check (CPC) Digital Comment Card Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Community Pulse Check (CPC) Digital Comment Card	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	001	CPC_SurveyWireframe2_v2_07162019.pdf	CPC_SurveyWireframe2_v2_07162019.pdf		Yes	Yes	Fillable Fileable
Form	001	CPC_SurveyWireframe2_v2_withNewQuestion_061719	CPC_SurveyWireframe2_v2_withNewQuestion_061719.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,000	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	9,000	9,000
Annual IC Time Burden (Hours)	750	750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Community Pulse Check (CPC) Digital Comment Card Request for Approval	CPC_FastTrackClearance_06.24.19.docx	06/24/2019

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