OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Individuals and Households Respondents

IC 263545 under ICR 202311-0584-003 · OMB 0584-0691.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
D1. Client Experience Survey.docx Other-D1. Client Experience Survey
D1. Client Experience Survey.docx Other-D1. Client Experience Survey
D2. Survey of Nonadopters.docx Other-D2. Survey of Nonadopters
D2. Survey of Nonadopters.docx Other-D2. Survey of Nonadopters
E1. Focus Group Discussion Guide.docx Other-E1. Focus Group Discussion Gui
E1. Focus Group Discussion Guide.docx Other-E1. Focus Group Discussion Gui
J1. Client Experience Survey Screenshots (English).docx Other-J1. Client Experience Survey S
J1. Client Experience Survey Screenshots (English).docx Other-J1. Client Experience Survey S
J2. Client Experience Survey Screenshots (Spanish).docx Other-J2. Client Experience Survey S
J2. Client Experience Survey Screenshots (Spanish).docx Other-J2. Client Experience Survey S
K1. Survey of Non-Adopters Screenshots (English).docx Other-K1. Survey of Non-Adopters Scr
K1. Survey of Non-Adopters Screenshots (English).docx Other-K1. Survey of Non-Adopters Scr
K2. Survey of Non-Adopters Screenshots (Spanish).docx Other-K2. Survey of Non-Adopters Scr
K2. Survey of Non-Adopters Screenshots (Spanish).docx Other-K2. Survey of Non-Adopters Scr
L1. Survey Invitation Letter.docx Other-L1. Survey Invitation Letter
L1. Survey Invitation Letter.docx Other-L1. Survey Invitation Letter
L2.1. Survey Email.docx Other-L2.1. Survey Email
L2.1. Survey Email.docx Other-L2.1. Survey Email
L2.2. Survey Text.docx Other-L2.2. Survey Text
L2.2. Survey Text.docx Other-L2.2. Survey Text
M1.1. Focus Group Recruitment Email.docx Other-M1.1. Focus Group Recruitment
M1.1. Focus Group Recruitment Email.docx Other-M1.1. Focus Group Recruitment
M1.2. Focus Group Recruitment Text.docx Other-M1.2. Focus Group Recruitment
M1.2. Focus Group Recruitment Text.docx Other-M1.2. Focus Group Recruitment
M3. Focus Group Screener.docx Other-M3. Focus Group Screener
M3. Focus Group Screener.docx Other-M3. Focus Group Screener
L3. Survey Reminder Letter.docx
L3. Survey Reminder Letter		IC Document
L3. Survey Reminder Letter.docx
L3. Survey Reminder Letter		IC Document
M2. Participant FAQ.docx
M2. Participant FAQ		IC Document
M2. Participant FAQ.docx
M2. Participant FAQ		IC Document
M4.1. Focus Group Reminder Email.docx
M4.1. Focus Group Reminder Email		IC Document
M4.1. Focus Group Reminder Email.docx
M4.1. Focus Group Reminder Email		IC Document
M4.2. Focus Group Reminder Text.docx
M4.2. Focus Group Reminder Text		IC Document
M4.2. Focus Group Reminder Text.docx
M4.2. Focus Group Reminder Text		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-D1. Client Experience Survey D1. Client Experience Survey.docx Yes Yes Fillable Fileable
Other-D2. Survey of Nonadopters D2. Survey of Nonadopters.docx Yes Yes Fillable Fileable
Other-E1. Focus Group Discussion Guide E1. Focus Group Discussion Guide.docx No   Paper Only
Other-J1. Client Experience Survey Screenshots (English) J1. Client Experience Survey Screenshots (English).docx Yes Yes Fillable Fileable
Other-J2. Client Experience Survey Screenshots (Spanish) J2. Client Experience Survey Screenshots (Spanish).docx Yes Yes Fillable Fileable
Other-K1. Survey of Non-Adopters Screenshots (English) K1. Survey of Non-Adopters Screenshots (English).docx Yes Yes Fillable Fileable
Other-K2. Survey of Non-Adopters Screenshots (Spanish) K2. Survey of Non-Adopters Screenshots (Spanish).docx Yes Yes Fillable Fileable
Other-L1. Survey Invitation Letter L1. Survey Invitation Letter.docx Yes No Printable Only
Other-L2.1. Survey Email L2.1. Survey Email.docx Yes No Printable Only
Other-L2.2. Survey Text L2.2. Survey Text.docx Yes Yes Fillable Fileable
Other-M1.1. Focus Group Recruitment Email M1.1. Focus Group Recruitment Email.docx Yes No Printable Only
Other-M1.2. Focus Group Recruitment Text M1.2. Focus Group Recruitment Text.docx Yes No Fillable Fileable
Other-M3. Focus Group Screener M3. Focus Group Screener.docx Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 167,377 0 167,377 0 0 0
Annual IC Time Burden (Hours) 4,380 0 4,380 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
L3. Survey Reminder Letter L3. Survey Reminder Letter.docx 11/17/2023
M2. Participant FAQ M2. Participant FAQ.docx 11/17/2023
M4.1. Focus Group Reminder Email M4.1. Focus Group Reminder Email.docx 11/17/2023
M4.2. Focus Group Reminder Text M4.2. Focus Group Reminder Text.docx 11/17/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.