Information Collection

Telephone Survey (including informed consent and screener)

IC 272261 under ICR 202405-0960-008 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A-1 NAS Questionnaire.docx	Other-New Applicant Survey Questionn
Attachment A-5 Information Sheet and Consent Form 06172024.pptx	Other-Information and Consent Form
Attachment A-11 Privacy Act Statement - Web Survey 06172024.jpg	Other-Privacy Act Statement

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-New Applicant Survey Questionnaire	Attachment A-1 NAS Questionnaire.docx	Yes	Yes	Fillable Fileable Signable
Other-Information and Consent Form	Attachment A-5 Information Sheet and Consent Form 06172024.pptx	Yes	Yes	Fillable Fileable Signable
Other-Privacy Act Statement	Attachment A-11 Privacy Act Statement - Web Survey 06172024.jpg	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,500	1,500
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	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.