Information Collection

Customer Satisfaction Survey for State Government Officials on ORD Research Area Coordination Teams

IC 268086 under ICR 202404-2030-001 · OMB 2030-0051.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5800-041 Customer Satisfaction Survey for State Government Officials on ORD Research Area Coordination Teams	Form
5800-041 ORD State Engagement Feedback Survey on RACT Participati ORD State Engagement Feedback Survey on RACT Participation.docx	Form
5800-041 ORD State Engagement Feedback Survey on RACT Participati ORD State Engagement Feedback Survey on RACT Participation.docx	Form
State RACT survey_justification.docx Justification	IC Document
State RACT survey_justification.docx Justification	IC Document

IC Title:

Agency IC Tracking Number:

2434.240

IC Status: New

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	5800-041	ORD State Engagement Feedback Survey on RACT Participation	ORD State Engagement Feedback Survey on RACT Participation.docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	State RACT survey_justification.docx	05/30/2024

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