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

OMB Control No.: 1405-0193
OMB Expiration Date: 07/31/2017
Estimated Burden: 3 minutes
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Customer Survey – Online Feedback Template

We Want to Hear From You!
Passport Services values your feedback. Please send us your feedback on your experiences with us. We
use this information to improve our service. Your responses will remain anonymous, unless otherwise
indicated by you below. Any identifying information provided will not be saved in our records.
For your protection, do not enter in any additional personal information or passport application
details into this form. For questions about a specific case or application, please call the National
Passport Information Center (NPIC) at 1-877-487-2778.
Is your feedback a compliment or a complaint?
Compliment

Complaint

Which of the following best describes the area of service your feedback pertains to?
Application Process

Passport Fees

Information Received

Customer Service

Other:
Where did you receive the service you are providing feedback for?
Acceptance Facility (Post Office,
Clerk of Court, Library, etc.)
Travel.State.Gov

U.S. Passport Agency

By Mail

National Passport Information Center, (800) 487-2778

For “Acceptance Facility” or “U.S. Passport Agency” above, please specify name and/or location:

Please give us your comments below.

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Would you like Passport Services to contact you if further information is needed on your
feedback?
Yes (Complete fields below)
No (Omit fields below)
First Name:
Telephone:
Email:

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including time required for searching existing data
sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to
supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate
and/or recommendations for reducing it, please send them to NPIC@state.gov