Information Collection

COSWD Activity Satisfaction Survey (OD)

IC 260022 under ICR 202307-0925-002 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 COSWD Activity Satisfaction Survey (OD)	Form and Instruction
1 Survey Attachment 1_COSWD_Instrument.docx	Form and Instruction
Template COSWD_Request.docx Template	IC Document
Attachment 2_COSWD_Listserv Survey Announcement_ Initial_Followup-5.2.docx Listserv Announcement	IC Document
Attachment 3_COSWD_Listserv Survey Template_5.2.docx Listserv Template	IC Document
Attachment 4_COSWD_Blog and Event Chat Survey Announcement_5.2.docx Blog and Event Announcement	IC Document

IC Title:

COSWD Activity Satisfaction Survey (OD)

Agency IC Tracking Number:

IC Status: Unchanged

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	1	Survey	Attachment 1_COSWD_Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template	Template COSWD_Request.docx	05/03/2023
Listserv Announcement	Attachment 2_COSWD_Listserv Survey Announcement_ Initial_Followup-5.2.docx	05/03/2023
Listserv Template	Attachment 3_COSWD_Listserv Survey Template_5.2.docx	05/03/2023
Blog and Event Announcement	Attachment 4_COSWD_Blog and Event Chat Survey Announcement_5.2.docx	05/03/2023

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