Worker Notification Feedback Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0953 Worker Notification Feedback Survey Form and Instruction
0920-0953 Worker Notification Feedback Survey survey_FINAL_08292018.docx Form and Instruction
IWSB fast track submission 082918.docx Generic Template IWSB IC Document

Information Collection (IC) Details

IC Title:	Worker Notification Feedback Survey	Agency IC Tracking Number:	0920-0953-18AYL

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 and Instruction	0920-0953	Worker Notification Feedback Survey	survey_FINAL_08292018.docx	NA	No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Template IWSB	IWSB fast track submission 082918.docx	08/31/2018

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