Standards Reference Materials (SRM) - Customer Satisfaction Data Collection

NIST Generic Request for Customer Service-Related Data Collections

0693-0031_ORM-SRM-Registration-CollectionInstrument

Standards Reference Materials (SRM) - Customer Satisfaction Data Collection

OMB: 0693-0031

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NIST Standard Reference Material (SRM) Registration System
NIST SRM Registration System

The NIST SRM Registration System allows you to receive notification of any
developments or updates to that product. Notification requires the SRM user’s
contact information. A user can register a maximum of thirteen SRMs.
This collection of information contains Paperwork Reduction Act (PRA) requirements approved by the Office of Management and
Budget (OMB). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to
a penalty for failure to comply with, a collection of information subject to the requirements of the PRA unless that collection of
information displays a currently valid OMB control number. Public reporting burden for this collection is estimated to be 7 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed
and completing and reviewing the collection of information. Comments regarding this burden estimate or any aspect of this collection of
information, including suggestions for reducing this burden, may be sent to the following:
National Institute of Standards and Technology
Attn: Tracy Hayat
Office of Reference Materials
100 Bureau Drive, Stop 2300
Gaithersburg, MD 20899-2300
Tel: 301-975-2092 E-mail: [email protected]
**Disclaimer**
You are accessing a U.S. Government information system, which includes: 1) this computer, 2) this computer network, 3) all computers
connected to this network, and 4) all devices and storage media attached to this network or to a computer on this network. You
understand and consent to the following: you may access this information system for authorized use only; you have no reasonable
expectation of privacy regarding any communication of data transiting or stored on this information system; at any time and for any
lawful Government purpose, the Government may monitor, intercept, and search and seize any communication or data transiting or
stored on this information system; and any communications or data transiting or stored on this information system may be disclosed or
used for any lawful Government purpose.

OMB Control No.: 0693-0031

OMB Expiration Date: May 31, 2018

NIST Standard Reference Material (SRM) Registration System
SRM User Contact Information

* NIST SRM User Information (Fields with an asterisk are required.)
*User First Name:
*User Surname:
*Organization/Company:
*Address:
Address (continued):
*City:
*State/Province:
Postal Code:
*Country:

Best Contact Method? (When selecting any of the options, ensure the information below is complete. More than one can be
selected.)
Phone

Fax

Phone Number (Field should only contain digits, spaces or dashes.)

Fax Number (Field should only contain digits, spaces or dashes.)

Email Address (Field should contain an @ symbol and a period.)

Email

NIST Standard Reference Material (SRM) Registration System
A (1) designates the first SRM you are registering. Fields with an asterisk (*) are required.

* (1) NIST SRM Information
(1) SRM/RM Number:
(1) Lot Number (if
available):
(1) Serial Number (if
available):

(1) What is the intended use of this SRM to your work?

* (1) Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (1) designates the first SRM you are registering. Fields with an asterisk (*) are required.
* (1) Purchase Information (Reseller/Distributor)

(1) Purchased from (Company Name)

(1) Order Date (MM/DD/YYY) (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (1) designates the first SRM you are registering. Fields with an asterisk (*) are required.

* (1) Purchase Information (NIST)
(1) Order Date
(MM/DD/YYYY):
(1) NIST Sales Order:
(1) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (2) designates the second SRM you are registering. Fields with an asterisk (*) are required.

* (2) NIST SRM Information
(2) SRM Number
Purchased:
(2) Lot Number (if
available):
(2) Serial Number (if
available):

(2) What is the intended use of this SRM to your work?

* (2) Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (2) designates the second SRM you are registering. Fields with an asterisk (*) are required.

* (2) Purchased from (Company Name)

(2) Order Date (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (2) designates the second SRM you are registering. Fields with an asterisk (*) are required.

* (2) Purchase Information (NIST)
(2) Order Date
(MM/DD/YYYY):
(2) NIST Sales Order:
(2) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (3) designates the third SRM you are registering. Fields with an asterisk (*) are required.

* (3) NIST SRM Information
(3) SRM Number
Purchased:
(3) Lot Number (if
available):
(3) Serial Number (if
available):

(3) What is the intended use of this SRM to your work?

* (3) Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (3) designates the third SRM you are registering. Fields with an asterisk (*) are required.

* (3) Purchased from (Company Name):

(3) Order Date (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (3) designates the third SRM you are registering. Fields with an asterisk (*) are required.

* (3) Purchase Information (NIST)
(3) Order Date
(MM/DD/YYYY):
(3) NIST Sales Order:
(3) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (4) designates the fourth SRM you are registering. Fields with an asterisk (*) are required.

* (4) NIST SRM Information
(4) SRM Number
Purchased:
(4) Lot Number (if
available):
(4) Serial Number (if
available):

(4) What is the intended use of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (4) designates the fourth SRM you are registering. Fields with an asterisk (*) are required.

* (4) Purchased from (Company Name)

(4) Order Date (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (4) designates the fourth SRM you are registering. Fields with an asterisk (*) are required.

* (4) Purchase Information (NIST)
(4) Order Date
(MM/DD/YYYY):
(4) NIST Sales Order
Number:
(4) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (5) designates the fifth SRM you are registering. Fields with an asterisk (*) are required.

* (5) NIST SRM Information
(5) SRM Number
Purchased:
(5) Lot Number (if
available):
(5) Serial Number (if
available):

(5) What is the intended use of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (5) designates the fifth SRM you are registering. Fields with an asterisk (*) are required.

* (5) Purchased from (Company Name):

(5) Order Date (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (5) designates the fifth SRM you are registering. Fields with an asterisk (*) are required.

* (5) Purchase Information (NIST)
(5) Order Date
(MM/DD/YYYY):
(5) NIST Sales Order
Number:
(5) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (6) designates the sixth SRM you are registering. Fields with an asterisk (*) are required.

* (6) NIST SRM Information
(6) SRM Number
Purchased:
(6) Lot Number (if
available):
(6) Serial Number (if
available):

(6) What is the intended use of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (6) designates the sixth SRM you are registering. Fields with an asterisk (*) are required.

* (6) Purchased from (Company Name):

* (6) Order Date: (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (6) designates the sixth SRM you are registering. Fields with an asterisk (*) are required.

* (6) Purchase Information (NIST)
(6) Order Date
(MM/DD/YYYY):
(6) NIST Sales Order
Number:
(6) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (7) designates the seventh SRM you are registering. Fields with an asterisk (*) are required.

* (7) NIST SRM Information
(7) SRM Number
Purchased:
(7) Lot Number (if
available):
(7) Serial Number (if
available):

(7) What is the application of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (7) designates the seventh SRM you are registering. Fields with an asterisk (*) are required.

* (7) Purchased from (Company Name):

* (7) Order Date: (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (7) designates the seventh SRM you are registering. Fields with an asterisk (*) are required.

* (7) Purchase Information (NIST)
(7) Order Date
(MM/DD/YYYY):
(7) NIST Sales Order
Number:
(7) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (8) designates the eighth SRM you are registering. Fields with an asterisk (*) are required.

* (8) NIST SRM Information
(8) SRM Number
Purchased:
(8) Lot Number (if
available):
(8) Serial Number (if
available):

(8) What is the intended use of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (8) designates the eighth SRM you are registering. Fields with an asterisk (*) are required.

* (8) Purchased from (Company Name):

* (8) Order Date: (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (8) designates the eighth SRM you are registering. Fields with an asterisk (*) are required.

* (8) Purchase Information (NIST)
(8) Order Date
(MM/DD/YYYY):
(8) NIST Sales Order
Number:
(8) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (9) designates the ninth SRM you are registering. Fields with an asterisk (*) are required.

* (9) NIST SRM Information
(9) SRM Number
Purchased:
(9) Lot Number (if
available):
(9) Serial Number (if
available):

(9) What is the intended use of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (9) designates the ninth SRM you are registering. Fields with an asterisk (*) are required.

* (9) Purchased from (Company Name):

* (9) Order Date: (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (9) designates the ninth SRM you are registering. Fields with an asterisk (*) are required.

* (9) Purchase Information (NIST)
(9) Order Date
(MM/DD/YYYY):
(9) NIST Sales Order
Number:
(9) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (10) designates the tenth SRM you are registering. Fields with an asterisk (*) are required.

* (10) NIST SRM Information
(10) SRM Number
Purchased:
(10) Lot Number (if
available):
(10) Serial Number (if
available):

(10) What is the intended use of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (10) designates the tenth SRM you are registering. Fields with an asterisk (*) are required.

* (10) Purchased from (Company Name):

* (10) Order Date: (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (10) designates the tenth SRM you are registering. Fields with an asterisk (*) are required.

* (10) Purchase Information (NIST)
(10) Order Date
(MM/DD/YYYY):
(10) NIST Sales Order
Number:
(10) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (11) designates the eleventh SRM you are registering. Fields with an asterisk (*) are required.

* (11) NIST SRM Information
(11) SRM Number
Purchased:
(11) Lot Number (if
available):
(11) Serial Number (if
available):

(11) What is the intended use of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (11) designates the eleventh SRM you are registering. Fields with an asterisk (*) are required.

* (11) Purchased from (Company Name):

* (11) Order Date: (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (11) designates the eleventh SRM you are registering. Fields with an asterisk (*) are required.

* (11) Purchase Information (NIST)
(11) Order Date
(MM/DD/YYYY):
(11) NIST Sales Order
Number:
(11) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (12) designates the twelfth SRM you are registering. Fields with an asterisk (*) are required.

* (12) NIST SRM Information
(12) SRM Number
Purchased:
(12) Lot Number (if
available):
(12) Serial Number (if
available):

(12) What is the intended us of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (12) designates the twelfth SRM you are registering. Fields with an asterisk (*) are required.

* (12) Purchased from (Company Name):

* (12) Order Date: (If not known, please approximate with the month and year.)

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (12) designates the twelfth SRM you are registering. Fields with an asterisk (*) are required.

* (12) Purchase Information (NIST)
(12) Order Date
(MM/DD/YYYY):
(12) NIST Sales Order
Number:
(12) Customer Purchase
Order:

* Would you like to register another NIST SRM?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (13) designates the thirteenth SRM you are registering. Fields with an asterisk (*) are
required.

* (13) NIST SRM Information
(13) SRM Number
Purchased:
(13) Lot Number (if
available):
(13) Serial Number (if
available):

(13) What is the intended use of this SRM to your work?

* Purchased directly from NIST?
Yes
No

NIST Standard Reference Material (SRM) Registration System
A (13) designates the thirteenth SRM you are registering. Fields with an asterisk (*) are
required.

* (13) Purchased from (Company Name):

* (13) Order Date: (If not known, please approximate with the month and year.)

* You have reached your SRM limit for this registration form. Click "Submit Registration" and then click
"Continue" to confirm and complete your registration. If you have additional SRMs to register, please open
up a new registration form. The SRM Registration System link is provided on the next page.
Submit Registration

NIST Standard Reference Material (SRM) Registration System
A (13) designates the thirteenth SRM you are registering. Fields with an asterisk (*) are required.

*

(13)

Purchase Information (NIST)

(13) Order Date
(MM/DD/YYYY):
(13) NIST Sales Order
Number:
(13) Customer Purchase
Order:

* You have reached your SRM limit for this registration form. Click "Submit Registration" and then click
"Submit" to confirm and complete your registration. If you have additional SRMs to register, please open up
a new registration form. The SRM Registration System link is provided on the next page.
Submit Registration


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File TitleView Survey
File Modified2018-04-16
File Created2018-03-13

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