AVA Feedback 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⚠️ Notice: This information collection may be referencing outdated material.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
ADA Feedback Form.docx Other-Feedback Form
ADA Feedback Form.docx Other-Feedback Form
1103-0117 Generic Clearance ADA-gov-PRA-request-073123.docx 1103-0117 Generic Clearance Request IC Document
1103-0117 Generic Clearance ADA-gov-PRA-request-073123.docx 1103-0117 Generic Clearance Request IC Document

Information Collection (IC) Details

IC Title:	AVA Feedback Form	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-Feedback Form			ADA Feedback Form.docx	ADA.gov	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	300,000	300,000
Annual IC Time Burden (Hours)	15,000	15,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
1103-0117 Generic Clearance Request	1103-0117 Generic Clearance ADA-gov-PRA-request-073123.docx	07/31/2023

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