Information Collection

Customer Assessment Survey

IC 258028 under ICR 202301-3220-003 · OMB 3220-0192.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0192 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-201 Customer Assessment Survey	Form and Instruction
G-201 Customer Assessment Survey Form G-201 (06-14).pdf	Form and Instruction
G-201 Customer Assessment Survey Form G-201 (06-14).pdf	Form and Instruction

IC Title:

Customer Assessment Survey

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	G-201	Customer Assessment Survey	Form G-201 (06-14).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.