Information Collection

Voluntary Customer Feedback Survey: General Information And Outreach Needs Of Small And Very Small Establishments

IC 231558 under ICR 201803-0583-003 · OMB 0583-0151.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0583-0151 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
outreach survey with Arabic translation.docx	Other-web survey Arabic
outreach survey with Chinese translation.docx	Other-web survey Chinese
outreach survey with Spanish translation 5-15-18.docx	Other-web survey Spanish
outreach survey with Vietnamese translation 5-15-18.docx	Other-web survey Vietnamese
Outreach Survey_S and VS Plants Final 5-23-18_highlighted.docx	Other-web survey
OMB Generic Clearance Template small and very small survey 5-23-18.docx Generic Clearance Template Small and Very Small Survey	IC Document

IC Title:

VOLUNTARY CUSTOMER FEEDBACK SURVEY: GENERAL INFORMATION AND OUTREACH NEEDS OF SMALL AND VERY SMALL ESTABLISHMENTS

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-web survey Arabic	outreach survey with Arabic translation.docx	Yes	Yes	Fillable Fileable
Other-web survey Chinese	outreach survey with Chinese translation.docx	Yes	Yes	Fillable Fileable
Other-web survey Spanish	outreach survey with Spanish translation 5-15-18.docx	Yes	Yes	Fillable Fileable
Other-web survey Vietnamese	outreach survey with Vietnamese translation 5-15-18.docx	Yes	Yes	Fillable Fileable
Other-web survey	Outreach Survey_S and VS Plants Final 5-23-18_highlighted.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,824

Number of Respondents for Small Entity: 4,824

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 94 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,824	4,824
Annual IC Time Burden (Hours)	884	884
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance Template Small and Very Small Survey	OMB Generic Clearance Template small and very small survey 5-23-18.docx	05/23/2018

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