Customer Satisfaction Survey for Healthier School Environments Workshops

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

Documents and Forms

Document Name Document Type
Form 5800-040 Customer Satisfaction Survey for Healthier School Environments Workshops Form
5800-040 HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFAC 2434ss60 Healthier Survey_ 2021.docx Form
5800-040 HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFAC 2434ss60 Healthier Survey_ 2021.docx Form
2434ss60 Healthier Survey Justification Revised 2021.docx Justification IC Document
2434ss60 Healthier Survey Justification Revised 2021.docx Justification IC Document

Information Collection (IC) Details

IC Title:	Customer Satisfaction Survey for Healthier School Environments Workshops	Agency IC Tracking Number:	2434.132

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	5800-040	HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFACTION SURVEY	2434ss60 Healthier Survey_ 2021.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: 1,250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,250	1,250
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	2434ss60 Healthier Survey Justification Revised 2021.docx	03/11/2021

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