Information Collection

Customer Interviews for Soliciting Feedback about the Department of Labor Employment and Benefits Security Administration

IC 257301 under ICR 202312-1225-004 · OMB 1225-0093.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0093 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer Interviews for Soliciting Feedback about the Department of Labor Employment and Benefits Security Administration	Form and Instruction
EBSA Customer Interviews Discussion Guide DOL_EBSA_Customer Interviews_Discussion Guide_V03.docx	Form and Instruction
EBSA Customer Interviews Discussion Guide DOL_EBSA_Customer Interviews_Discussion Guide_V03.docx	Form and Instruction
DOL_EBSA_ Customer Interviews_1225-0093 - A11 Section 280 Clearance_V02.docx 1225-0093 - Supporting Statement - EBSA Customer Interviews Discussion Guide	IC Document
DOL_EBSA_ Customer Interviews_1225-0093 - A11 Section 280 Clearance_V02.docx 1225-0093 - Supporting Statement - EBSA Customer Interviews Discussion Guide	IC Document
DOL_EBSA_Feedback_Customer Interviews_Consent Form_V02.docx EBSA Customer Interviews - Consent Form	IC Document
DOL_EBSA_Feedback_Customer Interviews_Consent Form_V02.docx EBSA Customer Interviews - Consent Form	IC Document

IC Title:

Customer Interviews for Soliciting Feedback about the Department of Labor Employment and Benefits Security Administration

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	NA	EBSA Customer Interviews Discussion Guide	DOL_EBSA_Customer Interviews_Discussion Guide_V03.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

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	15	15
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1225-0093 - Supporting Statement - EBSA Customer Interviews Discussion Guide	DOL_EBSA_ Customer Interviews_1225-0093 - A11 Section 280 Clearance_V02.docx	12/09/2022
EBSA Customer Interviews - Consent Form	DOL_EBSA_Feedback_Customer Interviews_Consent Form_V02.docx	12/09/2022

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