Information Collection

Be The Match Donation Experience Survey

IC 252323 under ICR 202401-0915-001 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

2024-01-10 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Be The Match Donation Experience Survey	Form and Instruction
Form 1 BTM Donation Experience Survey - CLEAN.docx Be The Match Donation Experience Survey	Form and Instruction
Form 1A Donation Experience Survey Be The Match Donation Experience Survey	Form and Instruction
Form 1B 12272023 - Attachment A - Redline Be The Match Donation Experience Survey	Form and Instruction
1 BTM Donation Experience Survey - CLEAN.docx Tab E - BTM Donation Experience Survey - CLEAN.docx	Form and Instruction
1 BTM Donation Experience Survey - CLEAN.docx Tab E - BTM Donation Experience Survey - CLEAN.docx	Form and Instruction
1A Donation Experience Survey 12272023 - Attachment A - Donation Experience Survey - Clean.docx	Form and Instruction
1A Donation Experience Survey 12272023 - Attachment A - Donation Experience Survey - Clean.docx	Form and Instruction
1B 12272023 - Attachment A - Redline 12272023 - Attachment A - Donation Experience Survey - Clean.docx	Form and Instruction
1B 12272023 - Attachment A - Redline 12272023 - Attachment A - Donation Experience Survey - Clean.docx	Form and Instruction
Tab A - Supporting Statement - CLEAN.docx Tab A - Supporting Statement - CLEAN	IC Document
Tab A - Supporting Statement - CLEAN.docx Tab A - Supporting Statement - CLEAN	IC Document
12272023 - Memo to OMB - Non-Substantive Change Req.docx 12272023 - Memo to OMB - Non-Substantive Change Req	IC Document
12272023 - Memo to OMB - Non-Substantive Change Req.docx 12272023 - Memo to OMB - Non-Substantive Change Req	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Be The Match Donation Experience Survey

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	BTM Donation Experience Survey - CLEAN.docx	Tab E - BTM Donation Experience Survey - CLEAN.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1A	Donation Experience Survey	12272023 - Attachment A - Donation Experience Survey - Clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1B	12272023 - Attachment A - Redline	12272023 - Attachment A - Donation Experience Survey - Clean.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,672

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,672	47	1,625
Annual IC Time Burden (Hours)	217	-1	218
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Tab A - Supporting Statement - CLEAN	Tab A - Supporting Statement - CLEAN.docx	03/22/2022
12272023 - Memo to OMB - Non-Substantive Change Req	12272023 - Memo to OMB - Non-Substantive Change Req.docx	01/02/2024

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