Information Collection

State and Local Human Services Customer Feedback

IC 228782 under ICR 201711-0970-005 · OMB 0970-0356.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0356 can be found here:

Documents and Forms

Document Name Document Type
App B Revised ACF State Customer Feedback Survey 11-16-17_clean.docx Other-Survey
App C Revised ACF County Customer Feedback Survey 11-16-17_clean.docx Other-Survey
App D Draft State and Local Customer Feedback Listening Sessions 10-24-17.docx Other-Listening Session Protocol
SSA Template State and Local Customer Feedback final 10-25-17.doc Supporting Statement A: State and Local Human Services Customer Feedback IC Document
SSB Template State and Local Customer Feedback Draft 10-24-17.doc Supporting Statement B: State and Local Human Services Customer Feedback IC Document
App A Email Invitation Customer Feedback Survey 10-25-17.docx Appendix A Email Invitation Customer Feedback Survey IC Document
OMB Cover Memo for revisions 11-16-17.docx Memo - NonSub Change State and Local Human Services IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State and Local Human Services Customer Feedback	Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	App B Revised ACF State Customer Feedback Survey 11-16-17_clean.docx	Yes	Yes	Fillable Fileable
Other-Survey	App C Revised ACF County Customer Feedback Survey 11-16-17_clean.docx	Yes	Yes	Fillable Fileable
Other-Listening Session Protocol	App D Draft State and Local Customer Feedback Listening Sessions 10-24-17.docx	No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 193	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	193	193
Annual IC Time Burden (Hours)	187	187
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A: State and Local Human Services Customer Feedback	SSA Template State and Local Customer Feedback final 10-25-17.doc	10/25/2017
Supporting Statement B: State and Local Human Services Customer Feedback	SSB Template State and Local Customer Feedback Draft 10-24-17.doc	10/25/2017
Appendix A Email Invitation Customer Feedback Survey	App A Email Invitation Customer Feedback Survey 10-25-17.docx	10/25/2017
Memo - NonSub Change State and Local Human Services	OMB Cover Memo for revisions 11-16-17.docx	11/16/2017

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