Information Collection

Customer Satisfaction Survey Template Blank

IC 233376 under ICR 201810-0960-002 · OMB 0960-0526.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0526 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Category A Mail Questionnaire Sample.docx	Other- Mail Quiestionnair Sample
Category B Telephone Questionnaire Sample.docx	Other-Telephone Questionnaire Sample
Category C Mail, Internet, Telphone Sample.docx	Other-Mail, Internet, Telephone Ques
Category D Comment Card Questionnaire Sample.docx	Other-Comment Card Questionnaire

IC Title:

Customer Satisfaction Survey Template Blank

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- Mail Quiestionnair Sample	Category A Mail Questionnaire Sample.docx	No		Paper Only
Other-Telephone Questionnaire Sample	Category B Telephone Questionnaire Sample.docx	No		Paper Only
Other-Mail, Internet, Telephone Questionnaire Sample	Category C Mail, Internet, Telphone Sample.docx	Yes	Yes	Fillable Printable
Other-Comment Card Questionnaire	Category D Comment Card Questionnaire Sample.docx	No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,887,065

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,887,065	5,887,065
Annual IC Time Burden (Hours)	1,129,339	1,129,339
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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