Information Access Center (IAC) Customer Comment Card

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

Customer Comment Card 3 29 2013

Information Access Center (IAC) Customer Comment Card

OMB: 1090-0011

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CUSTOMER COMMENT CARD

FORM APPROVED OMB NO. 1090-0011

Expires: 06/30/2015

Date: ________________
Reason for your visit: ____________________________________________________

Please Rate: Poor Fair Good Excellent

1Oval 41 Oval 42 Oval 44 Oval 45 Oval 46 Oval 47 Oval 48 Oval 49 Oval 50 Oval 51 Oval 52 Oval 53 Oval 54 Oval 55 Oval 56 Oval 57 Oval 58 Oval 59 Oval 60 Oval 61 . Quality of Service
2. Timeliness

3. Efficiency
4. Friendliness/Courtesy

5. Overall Experience
6. Please share one thing we could change that would improve your experience when

visiting the Information Access Center (IAC). ________________________________
______________________________________________________________________

______________________________________________________________________

**Please note additional comments on back of form.


Paperwork Reduction Act

The purpose of this survey is to provide information to the Bureau of Land Management for evaluating and improving the recreation

services and programs that it provides to the public. Response to this survey is voluntary. No action may be taken against you for

refusing to supply the information requested. The reporting burden for this form is estimated to average 1 minute, which includes the

time for reviewing instructions and completing and reviewing the form. An agency may not conduct or sponsor, and a person is not

required to respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control

number. Please direct comments regarding the burden estimate or any other aspect of this form to: U.S. Department of the Interior,

Bureau of Land Management (1040-0001), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Room

2134LM, Washington, D.C. 20240.


Privacy Act Statement

No Privacy Act Information is being collected; therefore, no direct link to the individual(s) filling out this survey will be available.

Information collected will be compiled to produce statistics.

File Typeapplication/msword
Authordasmith
Last Modified BySonneman, Jean E
File Modified2013-03-29
File Created2013-03-29

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