Technical Assistance (TA) Request Form

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0690-0030 can be found here:

Documents and Forms

Document Name Document Type
Technical Assistance (TA) Request Form Form and Instruction
Technical Assistance (TA0 Request Form Fast Track Technical Assistance Request Form 6-9-16.docx Form and Instruction
Customer Feedback Survey Fast Track Customer Feedback Survey 6-9-16.docx Form and Instruction
0690-0030 NTIA Fast Track Generic Clearance Request 6-9-16_060316.docx Technical Assistance (TA Request Form IC Document

Information Collection (IC) Details

IC Title:	Technical Assistance (TA) Request Form	Agency IC Tracking Number:

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	NA	Technical Assistance (TA0 Request Form	Fast Track Technical Assistance Request Form 6-9-16.docx		Yes	Yes	Fillable Fileable
Form and Instruction	NA	Customer Feedback Survey	Fast Track Customer Feedback Survey 6-9-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 20

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Technical Assistance (TA Request Form	0690-0030 NTIA Fast Track Generic Clearance Request 6-9-16_060316.docx	06/14/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.