Feedback Survey: NWEJC Launch Event

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Renewal)

Documents and Forms

Document Name Document Type
Form 5800-095 Feedback Survey: NWEJC Launch Event Form
5800-095 Feedback Survey: Northwest Environmental Justice Center Feedback Survey Northwest Environmental Justice Center Launch Event .docx Form
5800-095 Feedback Survey: Northwest Environmental Justice Center Feedback Survey Northwest Environmental Justice Center Launch Event .docx Form
Justification for Generic Customer Service Collection Request_NWEJC.docx Justifiication IC Document
Justification for Generic Customer Service Collection Request_NWEJC.docx Justifiication IC Document

Information Collection (IC) Details

IC Title:	Feedback Survey: NWEJC Launch Event	Agency IC Tracking Number:	2434.278

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	5800-095	Feedback Survey: Northwest Environmental Justice Center Launch Event	Feedback Survey Northwest Environmental Justice Center Launch Event .docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 135	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 80 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	135	135
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justifiication	Justification for Generic Customer Service Collection Request_NWEJC.docx	05/31/2024

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