Community Relations Service Evaluation Form

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1103-0117 can be found here:

Documents and Forms

Document Name Document Type
GEN IC Form - CRS Small Group TOF Evaluation Form 1103-0117.docx Other-Survey
GEN IC Form - CRS Small Group TOF Evaluation Form 1103-0117.docx Other-Survey
Generic IC Template - CRS Small Group TOF Evaluation Form 1103-0117.pdf CRS Small Group TOF Evaluation Form IC Document
Generic IC Template - CRS Small Group TOF Evaluation Form 1103-0117.pdf CRS Small Group TOF Evaluation Form IC Document

Information Collection (IC) Details

IC Title:	Community Relations Service Evaluation Form	Agency IC Tracking Number:

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
Other-Survey			GEN IC Form - CRS Small Group TOF Evaluation Form 1103-0117.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CRS Small Group TOF Evaluation Form	Generic IC Template - CRS Small Group TOF Evaluation Form 1103-0117.pdf	04/06/2023

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