Information Collection

DELTA Reverse Site Visit Feedback

IC 243166 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1050 DELTA Reverse Site Visit Feedback	Form and Instruction
Att. 2 - Invitation emil.docx	Other-Email
0920-1050 2020 Reverse Site Visit Feedback Form Att. 1_- 2020 Reverse Site Visit Feedback Form.docx	Form and Instruction
1050 Generic Request - DELTA Reverse Site Visit Feedback8.6.20.docx Request for Approval	IC Document
At. 3 - Privacy.pdf Att 3_Privacy	IC Document

IC Title:

DELTA Reverse Site Visit Feedback

Agency IC Tracking Number:

0920-1050-20RJ

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
Form and Instruction	0920-1050	2020 Reverse Site Visit Feedback Form	Att. 1_- 2020 Reverse Site Visit Feedback Form.docx		Yes	Yes	Fillable Fileable
Other-Email			Att. 2 - Invitation emil.docx		No		Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	120	120
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	1050 Generic Request - DELTA Reverse Site Visit Feedback8.6.20.docx	08/13/2020
Att 3_Privacy	At. 3 - Privacy.pdf	08/13/2020

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