Information Collection

Quality Assessment Survey

IC 238265 under ICR 201804-1405-001 · OMB 1405-0193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0193 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1_QA Survey_ main.pdf	Other-Survey
2_QA Survey_subject v source.pdf	Other-Survey - 2
3_QA Survey_subject_PA provided (Q2).pdf	Other-Survey - 3
4_QA Survey_source_PA cited (Q2).pdf	Other-Survey - 4
5_QA Survey_subject-source_in-person_re-contact_no.pdf	Other-Survey - 5
6_QA Survey_subject-source_in-person_re-contact_yes.pdf	Other-Survey - 6
7_QA Survey_subject-source_telephone-email_recontact_yes.pdf	Other-Survey - 7
8_QA Survey_subject-source_telephone-email_recontact_yes two.pdf	Other-Survey
DS-PSS Generic Clearance Submission Template.doc Quality Assessment - Generic Clearance Submission	IC Document

IC Title:

Quality Assessment Survey

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-Survey	1_QA Survey_ main.pdf	Yes	Yes	Fillable Fileable
Other-Survey - 2	2_QA Survey_subject v source.pdf	Yes	Yes	Fillable Fileable
Other-Survey - 3	3_QA Survey_subject_PA provided (Q2).pdf	Yes	Yes	Fillable Fileable
Other-Survey - 4	4_QA Survey_source_PA cited (Q2).pdf	Yes	Yes	Fillable Fileable
Other-Survey - 5	5_QA Survey_subject-source_in-person_re-contact_no.pdf	Yes	Yes	Fillable Fileable
Other-Survey - 6	6_QA Survey_subject-source_in-person_re-contact_yes.pdf	Yes	Yes	Fillable Fileable
Other-Survey - 7	7_QA Survey_subject-source_telephone-email_recontact_yes.pdf	Yes	Yes	Fillable Fileable
Other-Survey	8_QA Survey_subject-source_telephone-email_recontact_yes two.pdf	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	22,500	22,500
Annual IC Time Burden (Hours)	1,125	1,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Quality Assessment - Generic Clearance Submission	DS-PSS Generic Clearance Submission Template.doc	10/24/2019

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