Information Collection

COSWD Activity Satisfaction Survey (OD)

IC 260022 under ICR 202103-0925-003 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey COSWD Activity Satisfaction Survey (OD)	Form and Instruction
1 Survey Attachment 1_COSWD_Instrument.docx	Form and Instruction
Template COSWD_Request.docx Template	IC Document
Attachment 2_COSWD_Listserv Survey Announcement_ Initial_Followup-5.2.docx Listserv Announcement	IC Document
Attachment 3_COSWD_Listserv Survey Template_5.2.docx Listserv Template	IC Document
Attachment 4_COSWD_Blog and Event Chat Survey Announcement_5.2.docx Blog and Event Announcement	IC Document

IC Title:

COSWD Activity Satisfaction Survey (OD)

Agency IC Tracking Number:

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 and Instruction	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	600	600
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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