Information Collection

Dating Matters Customer Satisfaction Survey

IC 239565 under ICR 201902-0920-022 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.