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Customer Satisfaction Surveys for feedback on the EJ TCTACs
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Renewal)
OMB: 2030-0051
IC ID: 268115
OMB.report
EPA/OMS
OMB 2030-0051
ICR 202404-2030-001
IC 268115
( )
Documents and Forms
Document Name
Document Type
Form 5800-091
Customer Satisfaction Surveys for feedback on the EJ TCTACs
Form
5800-091 EJ TCTAC Intake Form Center A
Center A_Northwest Environmental Justice Center.docx
Form
5800-091 EJ TCTAC Intake Form Center A
Center A_Northwest Environmental Justice Center.docx
Form
5800-092 EJ TCTAC Intake Form Center B
Center B_EAGLE.docx
Form
5800-092 EJ TCTAC Intake Form Center B
Center B_EAGLE.docx
Form
5800-093 EJ TCTAC Intake Form Center C
Center C_NIHB.docx
Form
5800-093 EJ TCTAC Intake Form Center C
Center C_NIHB.docx
Form
EJ TCTACs Survey IC Justification.docx
Justification
IC Document
EJ TCTACs Survey IC Justification.docx
Justification
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Customer Satisfaction Surveys for feedback on the EJ TCTACs
Agency IC Tracking Number:
2434.264
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
5800-091
EJ TCTAC Intake Form Center A
Center A_Northwest Environmental Justice Center.docx
Yes
Yes
Fillable Fileable
Form
5800-092
EJ TCTAC Intake Form Center B
Center B_EAGLE.docx
Yes
Yes
Fillable Fileable
Form
5800-093
EJ TCTAC Intake Form Center C
Center C_NIHB.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Environmental Management
Subfunction:
Environmental Monitoring and Forecasting
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,500
Number of Respondents for Small Entity:
1,500
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,500
0
1,500
0
0
0
Annual IC Time Burden (Hours)
375
0
375
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Justification
EJ TCTACs Survey IC Justification.docx
05/30/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.