Reporting and Recordkeeping Requirements

INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-I: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.

TITLE OF INFORMATION COLLECTION DOCUMENT

OMB NO.

0560-0286

FSA's Qualitative Feedback on Agency Service Delivery (FSA Fast Track)

DATE PREPARED

October 29, 2020

IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT

ANNUAL BURDEN

REPORTS

RECORDS

RESPONDENT COST

TOTAL BURDEN HOURS

TOTAL

FORMS NO (S)

NO. OF

NO OF

TOTAL ANNUAL

HOURS

(Col. F x G)

NO. OF

ANNUAL

RECORD-

COST

TOTAL

SECTION OF

DESCRIPTION

(If "none"

RESPONDENTS

RESPONSES

RESPONSES

PER

(H)

RECORD-

HOURS PER

KEEPING HOURS

PER

COST

REGS.

so state)

PER

(Col. D x E)

RESPONSE

KEEPERS

RECORD-

(Col. I x J)

HOUR

(Col. H x L)

RESPONDENT

EXEMPT

NON-EXEMPT

KEEPER

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(I)

(J)

(K)

(L)

(M)

eO 12862

Customer Survey

200,000

1

200,000

0.17

33,333

0

Comment Cards

10,000

1

10,000

0.25

2,500

0

Focus group

500

1

500

3.00

1,500

0

0

SUBTOTAL

210,500

0

37,333

0.00

0

TOTAL OF ALL PAGES

210,500

0

37,333

0.00

0

TOTAL - COLUMNS "F" AND "I" = OMB 83-I, 13b; COLUMNS "H" AND "K" = OMB 83-I, 13c

210,500

37,333