Dating Matters Customer Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
Att 1_ Recruitment Letter.docx Instruction
0920-1050 Online Survey - Interview Guide Att 2_ Prong 1 Online Survey.docx Form and Instruction
0920-1050 Remote Interview Guide Att3_ Prong 2 Remote Video Interviews.docx Form and Instruction
0920-1050 GenIC Request_Dating Matters1.4.20.ka.docx GenIC Request IC Document

Information Collection (IC) Details

IC Title:	Dating Matters Customer Satisfaction Survey	Agency IC Tracking Number:	0920-1050-20GG

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
Instruction			Att 1_ Recruitment Letter.docx	NA	Yes	No	Printable Only
Form and Instruction	0920-1050	Online Survey - Interview Guide	Att 2_ Prong 1 Online Survey.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Remote Interview Guide	Att3_ Prong 2 Remote Video Interviews.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 567	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	567	567
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request	0920-1050 GenIC Request_Dating Matters1.4.20.ka.docx	01/29/2020

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