Information Collection

Host Agency Customer Satisfaction – ETA-9124B

IC 185407 under ICR 202401-1205-001 · OMB 1205-0040.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Host Agency Customer Satisfaction â 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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.