Surveillance Systems Feedback Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Surveillance Systems Feedback Survey Form
Systems Application Feedback Appendix A_Survey Instrument.docx Form
Surveillance system applications.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Surveillance Systems Feedback Survey	Agency IC Tracking Number:	0920-0953-19AD

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	none	Systems Application Feedback	Appendix A_Survey Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 858	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	858	858
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Surveillance system applications.docx	10/04/2018

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