PBGC Retiree Survey-051-20253 A4-rev

American Customer Satisfaction Index "Customer Satisfaction Surveys"

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Document Name Document Type
Form 051-20253 A4-rev PBGC Retiree Survey-051-20253 A4-rev Form and Instruction
051-20253 A4-rev PBGC Retiree Survey 051-20253 A4-rev Retiree ACSI Instrument 2019_v2-rev.docx Form and Instruction
Generic Clearance Request Form_-signed.pdf Generic Clearance Request Form for PBGC Retiree Survey 051-20253 A4-rev IC Document
PBGC Retiree 2019_OMB Mapping Cover_v2.xlsx OMB Mapping Cover for PBGC Retiree Survey-rev IC Document

Information Collection (IC) Details

IC Title:	PBGC Retiree Survey-051-20253 A4-rev	Agency IC Tracking Number:	051-20253 A4-rev

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	051-20253 A4-rev	PBGC Retiree Survey 051-20253 A4-rev	Retiree ACSI Instrument 2019_v2-rev.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Clearance Request Form for PBGC Retiree Survey 051-20253 A4-rev	Generic Clearance Request Form_-signed.pdf	05/30/2019
OMB Mapping Cover for PBGC Retiree Survey-rev	PBGC Retiree 2019_OMB Mapping Cover_v2.xlsx	05/30/2019

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