Evaluation of Mediation Services (Participant) - IC for Individual or Household Respondents

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

Documents and Forms

Document Name Document Type
Form 3320 0004(1) Evaluation of Mediation Services (Participant) - IC for Individual or Household Respondents Form and Instruction
3320 0004(1) Mediation Services Participant Questionnaire Rev 2012 Mediation Services Participant Questionnaire _Rev 2012_.pdf Note: Electronic version currently being finalized Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation of Mediation Services (Participant) - IC for Individual or Household Respondents	Agency IC Tracking Number:	0004d

Is this a Common Form? No		IC Status: Modified

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 Rev 2012	Mediation Services Participant Questionnaire _Rev 2012_.pdf	Note: Electronic version currently being finalized	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: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	15	385
Annual IC Time Burden (Hours)	120	-8	128
Annual IC Cost Burden (Dollars)	0	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.