DELTA Reverse Site Visit Feedback

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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.