Voluntary Customer Feedback Survey: General Information And Outreach Needs Of Small And Very Small Establishments

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⚠️ Notice: This information collection may be referencing outdated material.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 0583-0151 can be found here:

Documents and Forms

Document Name Document Type
outreach survey with Arabic translation.docx Other-web survey Arabic
outreach survey with Chinese translation.docx Other-web survey Chinese
outreach survey with Spanish translation 5-15-18.docx Other-web survey Spanish
outreach survey with Vietnamese translation 5-15-18.docx Other-web survey Vietnamese
Outreach Survey_S and VS Plants Final 5-23-18_highlighted.docx Other-web survey
OMB Generic Clearance Template small and very small survey 5-23-18.docx Generic Clearance Template Small and Very Small Survey IC Document

Information Collection (IC) Details

IC Title:	VOLUNTARY CUSTOMER FEEDBACK SURVEY: GENERAL INFORMATION AND OUTREACH NEEDS OF SMALL AND VERY SMALL ESTABLISHMENTS	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-web survey Arabic	outreach survey with Arabic translation.docx	Yes	Yes	Fillable Fileable
Other-web survey Chinese	outreach survey with Chinese translation.docx	Yes	Yes	Fillable Fileable
Other-web survey Spanish	outreach survey with Spanish translation 5-15-18.docx	Yes	Yes	Fillable Fileable
Other-web survey Vietnamese	outreach survey with Vietnamese translation 5-15-18.docx	Yes	Yes	Fillable Fileable
Other-web survey	Outreach Survey_S and VS Plants Final 5-23-18_highlighted.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,824	Number of Respondents for Small Entity: 4,824

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 94 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,824	4,824
Annual IC Time Burden (Hours)	884	884
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Clearance Template Small and Very Small Survey	OMB Generic Clearance Template small and very small survey 5-23-18.docx	05/23/2018

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