Guest Speaker Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Renewal)

Documents and Forms

Document Name Document Type
Form 5800-039 Guest Speaker Survey Form
5800-039 Guest Speaker Survey Survey_questions.docx Form
5800-039 Guest Speaker Survey Survey_questions.docx Form
e-Manifest_Oct_webinar_Clearance_Submission.pdf Justification IC Document
e-Manifest_Oct_webinar_Clearance_Submission.pdf Justification IC Document

Information Collection (IC) Details

IC Title:	Guest Speaker Survey	Agency IC Tracking Number:	2434.131

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	5800-039	Guest Speaker Survey	Survey_questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 140	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	140	140
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	e-Manifest_Oct_webinar_Clearance_Submission.pdf	03/11/2021

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