ADA Feedback Form

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

Documents and Forms

Document Name Document Type
AVA Feedback Form.pdf Other-
AVA Feedback Form.pdf Other-
Gen IC Template-062724-RA.docx Gen IC Template-062724-RA IC Document
Gen IC Template-062724-RA.docx Gen IC Template-062724-RA IC Document

Information Collection (IC) Details

IC Title:	ADA Feedback Form	Agency IC Tracking Number:

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
Other-			AVA Feedback Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90,000,000,000	90,000,000,000
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Gen IC Template-062724-RA	Gen IC Template-062724-RA.docx	06/28/2024

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