Information Collection

Environmental Justice Scorecard Feedback Survey

IC 259359 under ICR 202206-0331-001 · OMB 0331-0004.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Environmental Justice Scorecard Feedback Survey Environmental Justice Scorecard Feedback Survey	Form
Environmental Justice Scorecard Feedback Survey EJ Scorecard - Satisfaction Survey.docx	Form
EJ Scorecard - Satisfaction Survey - Request for Approval.docx Request for Approval under the Generic Clearance for the Collection of Routine Customer Feedback	IC Document

IC Title:

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	N/A			Pending	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval under the Generic Clearance for the Collection of Routine Customer Feedback		03/29/2023

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

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