1103-0117 Long Impact Survey Gen IC

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⚠️ Notice: This information collection may be referencing outdated material.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
TA Recipient Long-Term Post-TA Impact Survey.docx Other-Survey
TA Recipient Long-Term Post-TA Impact Survey.docx Other-Survey
1103-0117 Long Impact Survey Gen IC.docx 1103-0117 Long Impact Survey Gen IC IC Document
1103-0117 Long Impact Survey Gen IC.docx 1103-0117 Long Impact Survey Gen IC IC Document

Information Collection (IC) Details

IC Title:	1103-0117 Long Impact Survey Gen IC	Agency IC Tracking Number:

IC Status: Unchanged

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			TA Recipient Long-Term Post-TA Impact Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
1103-0117 Long Impact Survey Gen IC	1103-0117 Long Impact Survey Gen IC.docx	05/05/2023

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