PSA Surveys

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2010-0042 can be found here:

Documents and Forms

Document Name Document Type
2434ss72 PSA Surveys-Demographic and Consent Form.docx Other-Other
2434ss72 PSA Surveys-Focus Group Studies.docx Other-Other
2434ss72 PSA Surveys-HCNScript1.pdf Other-Other
2434ss72 PSA Surveys-HCNScript2.pdf Other-Other
2434ss72 PSA Surveys-HCNScript3.pdf Other-Other
2434ss72 PSA Surveys-HCNScript4.pdf Other-Other
2434ss72 PSA Surveys-HCNScript5.pdf Other-Other
2434ss72 PSA Surveys-HCNScript6.pdf Other-Other
2434ss72 PSA Surveys Justification.docx 2434ss72 PSA Surveys Justification IC Document

Information Collection (IC) Details

IC Title:	PSA Surveys	Agency IC Tracking Number:	2434.72

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Other	2434ss72 PSA Surveys-Demographic and Consent Form.docx	No	Paper Only
Other-Other	2434ss72 PSA Surveys-Focus Group Studies.docx	No	Paper Only
Other-Other	2434ss72 PSA Surveys-HCNScript1.pdf	No	Paper Only
Other-Other	2434ss72 PSA Surveys-HCNScript2.pdf	No	Paper Only
Other-Other	2434ss72 PSA Surveys-HCNScript3.pdf	No	Paper Only
Other-Other	2434ss72 PSA Surveys-HCNScript4.pdf	No	Paper Only
Other-Other	2434ss72 PSA Surveys-HCNScript5.pdf	No	Paper Only
Other-Other	2434ss72 PSA Surveys-HCNScript6.pdf	No	Paper Only

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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	40	40
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2434ss72 PSA Surveys Justification	2434ss72 PSA Surveys Justification.docx	05/04/2017

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