Information Collection

SimpleReport Online Surveys

IC 252250 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⚠️ Notice: This information collection may be referencing outdated material.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 SimpleReport TouchPoint Survey SimpleReport Online Surveys	Form
0920-1050 SimpleReport TouchPoint Survey SimpleReport Touchpoints online surveys draft 3_2022.docx	Form
0920-1050_Customer_Service_GenIC_Clearance_SimpleReport online surveys.docx 0920-1050 GenIC Request Template	IC Document

IC Title:

SimpleReport Online Surveys

Agency IC Tracking Number:

0920-1050-22DM

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	0920-1050			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	200	200
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0920-1050 GenIC Request Template		03/18/2022

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

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