Research Participation Interest Form

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
Research Participation Interest Form Form
FDG Screener Survey Research Participation Screening Survey.pdf Form
FDG Screener Survey Research Participation Screening Survey.pdf Form
Generic_Clearance_Submission_Research Interest Form.docx Request for Approval IC Document
Generic_Clearance_Submission_Research Interest Form.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Research Participation Interest Form	Agency IC Tracking Number:	2024R6

IC Status: New

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
Form	NA	FDG Screener Survey	Research Participation Screening Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Generic_Clearance_Submission_Research Interest Form.docx	01/22/2024

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