Evaluation of Mediation Services (Participant) - IC for State, Local and Tribal Govt. Respondents

Program Evaluation Instruments - Collaborative Problem Solving Mediation Services (Two Instruments)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3320-0004 can be found here:

Documents and Forms

Document Name Document Type
Form 3320-0004(1) Evaluation of Mediation Services (Participant) - IC for State, Local and Tribal Govt. Respondents Form and Instruction
3320-0004(1) Mediation Services - Participant Questionnaire (Paper) Mediation Services - Participant Questionnaire (Paper).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation of Mediation Services (Participant) - IC for State, Local and Tribal Govt. Respondents	Agency IC Tracking Number:	0004b

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	3320-0004(1)	Mediation Services - Participant Questionnaire (Paper)	Mediation Services - Participant Questionnaire (Paper).pdf		Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	200	200
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.