Qualtrics Omnichannel OMB A-11

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⚠️ Notice: This information collection may be referencing outdated material.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 1615-0121 can be found here:

Documents and Forms

Document Name Document Type
-USCIS Survey - English-OMB A-11 Qs-2019.docx Other-Generic Clearance
Qualtrics-Omnichannel Supporting Statement 20191024.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Qualtrics Omnichannel OMB A-11	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
Other-Generic Clearance			-USCIS Survey - English-OMB A-11 Qs-2019.docx		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title: Correspondence Records	FR Citation: 83 FR 48645

Number of Respondents: 60,033	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	60,033	60,033
Annual IC Time Burden (Hours)	3,502	3,502
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Qualtrics-Omnichannel Supporting Statement 20191024.docx	10/24/2019

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