Information Collection

A11-23-2 Direct Pay Survey

IC 243661 under ICR 202306-1545-013 · OMB 1545-2290.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A11-23-2 Medallia - Direct Pay Survey.xlsx	Other-Attachment
A11-23-2 Medallia - Direct Pay Survey.xlsx	Other-Attachment
A11-23-2 Direct Pay Survey A11 Supporting Statement_20230322.docx A11-23-2 Direct Pay Survey	IC Document
A11-23-2 Direct Pay Survey A11 Supporting Statement_20230322.docx A11-23-2 Direct Pay Survey	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Modified

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
Other-Attachment			A11-23-2 Medallia - Direct Pay Survey.xlsx		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,000	19,472	528
Annual IC Time Burden (Hours)	333	289	44
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A11-23-2 Direct Pay Survey	A11-23-2 Direct Pay Survey A11 Supporting Statement_20230322.docx	07/10/2023

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