EBSA Participant Assistance Program Customer Survey

Documents and Forms

Document Name Document Type
Gallup Customer Service Survery Instrument Final 3-31-2020.docx Other-Survey Instrument
1210-0161 Gallup Customer Service Survery Instrument with Additional Demographic questions added CLEAN.docx Other-Survey Instrument

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EBSA Participant Assistance Program Customer Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Survey Instrument			1210-0161 Gallup Customer Service Survery Instrument with Additional Demographic questions added CLEAN.docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	11,200	0	11,200
Annual IC Time Burden (Hours)	1,867	374	1,493
Annual IC Cost Burden (Dollars)	0	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.