Customer Service - HEADS UP Rocket Blades

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1009 can be found here:

Documents and Forms

Document Name Document Type
Customer Service - HEADS UP Rocket Blades Form and Instruction
Child Survey - HEADS UP_Rocket Blades Child Survey_HEADS UP - Rocket Blades.doc Form and Instruction
Parent Survey - HEADS UP_Rocket Blades Parent Survey_HEADS UP-Rocket Blades.docx Form and Instruction
Attachment A_Add HEADS-UP-Rocket Blades_ICRO.docx Participation Announcement IC Document
Attachment B_ Participant Consent Form HEADS UP_IncICRO.docx Participant Consent IC Document
GenIC Request_HEADS UP-Rocket Blades_IncICRO.docx GenIC Request IC Document

Information Collection (IC) Details

IC Title:	Customer Service - HEADS UP Rocket Blades	Agency IC Tracking Number:	16XC

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	Child Survey - HEADS UP_Rocket Blades	Child Survey_HEADS UP - Rocket Blades.doc	NA	No		Paper Only
Form and Instruction	NA	Parent Survey - HEADS UP_Rocket Blades	Parent Survey_HEADS UP-Rocket Blades.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Participation Announcement	Attachment A_Add HEADS-UP-Rocket Blades_ICRO.docx	03/28/2016
Participant Consent	Attachment B_ Participant Consent Form HEADS UP_IncICRO.docx	03/28/2016
GenIC Request	GenIC Request_HEADS UP-Rocket Blades_IncICRO.docx	03/28/2016

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