Qualtrics Platform Survey

Qualtrics Platform Survey for the Bureau of Educational and Cultural Affairs (ECA)

Documents and Forms

Document Name Document Type
Form DS-7101 Qualtrics Platform Survey Form and Instruction
DS-7101 Qualtrics Platform Survey Qualtrics MODE Survey Builder - Screenshots.pptx Form and Instruction

Information Collection (IC) Details

IC Title:	Qualtrics Platform Survey	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	DS-7101	Qualtrics Platform Survey	Qualtrics MODE Survey Builder - Screenshots.pptx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: Qualtrics Platform Survey	FR Citation: 89 FR 12575

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.