Information Collection

Qualtrics Omnichannel OMB A-11

IC 238258 under ICR 201801-1615-001 · OMB 1615-0121.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1615-0121 can be found here:

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Qualtrics Omnichannel OMB A-11

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.