Host Agency Customer Satisfaction – ETA-9124B

Senior Community Service Employment Program (SCSEP)

Documents and Forms

Document Name Document Type
Form ETA 9124B Host Agency Customer Satisfaction – ETA-9124B Form
ETA 9124B Host Agency Survey ETA-9124B_HOST AGENCY Survey_11523.pdf Form
ETA 9124B Host Agency Survey ETA-9124B_HOST AGENCY Survey_11523.pdf Form

Information Collection (IC) Details

IC Title:	Host Agency Customer Satisfaction – ETA-9124B	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR Part 641 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA 9124B	Host Agency Survey	ETA-9124B_HOST AGENCY Survey_11523.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,645	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,645	4,617	28
Annual IC Time Burden (Hours)	604	-54	658
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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