Evaluation of Roster Program (Roster Member) - IC for State, Local and Tribal Govt. Respondents

Program Evaluation Instruments - Roster Program Services (Two Instruments)

Documents and Forms

Document Name Document Type
Form 3320-0005(2) Evaluation of Roster Program (Roster Member) - IC for State, Local and Tribal Govt. Respondents Form and Instruction
3320-0005(2) Roster Services - Member Questionnaire (Rev 2012) Roster Services Member Questionnaire _Rev 2012.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation of Roster Program (Roster Member) - IC for State, Local and Tribal Govt. Respondents	Agency IC Tracking Number:	0005b RMs

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	3320-0005(2)	Roster Services - Member Questionnaire (Rev 2012)	Roster Services Member Questionnaire _Rev 2012.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: 5	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	-5	10
Annual IC Time Burden (Hours)	0	-1	1
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.