Federal Feedback Button - Dept. of State

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⚠️ Notice: This information collection may be referencing outdated material.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 1405-0193 can be found here:

Documents and Forms

Document Name Document Type
Form SV-2015-0007 Federal Feedback Button - Dept. of State Form
SV-2015-0007 State Kiosk Survey State Kiosk Survey (6-2015).jpg Form
State Kiosk sign with OMB-PRA (attached to Kiosk) 6-2015.pdf Signage for Kiosk IC Document
Generic Clearance Submission Template State Kiosk Survey (6-2015).pdf Generic Clearance Submission Template IC Document

Information Collection (IC) Details

IC Title:	Federal Feedback Button - Dept. of State	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	SV-2015-0007	State Kiosk Survey	State Kiosk Survey (6-2015).jpg		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 76,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	76,000	76,000
Annual IC Time Burden (Hours)	215	215
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Signage for Kiosk	State Kiosk sign with OMB-PRA (attached to Kiosk) 6-2015.pdf	06/22/2015
Generic Clearance Submission Template	Generic Clearance Submission Template State Kiosk Survey (6-2015).pdf	06/22/2015

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