Information Collection

UAC Satisfaction Survey (Form A-11 & A-11s)

IC 241080 under ICR 202004-0970-002 · OMB 0970-0547.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0547 can be found here:

Documents and Forms

Document Name Document Type
UAC Satisfaction Survey (Form A-11).pdf Other-Survey
UAC Satisfaction Survey (Form A-11s).pdf Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	UAC Satisfaction Survey (Form A-11 & A-11s)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			UAC Satisfaction Survey (Form A-11).pdf		No		Paper Only
Other-Survey			UAC Satisfaction Survey (Form A-11s).pdf		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 72,840	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	72,840	72,840
Annual IC Time Burden (Hours)	24,280	24,280
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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