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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
1_QA Survey_ main.pdf Other-Survey
2_QA Survey_subject v source.pdf Other-Survey - 2
3_QA Survey_subject_PA provided (Q2).pdf Other-Survey - 3
4_QA Survey_source_PA cited (Q2).pdf Other-Survey - 4
5_QA Survey_subject-source_in-person_re-contact_no.pdf Other-Survey - 5
6_QA Survey_subject-source_in-person_re-contact_yes.pdf Other-Survey - 6
7_QA Survey_subject-source_telephone-email_recontact_yes.pdf Other-Survey - 7
8_QA Survey_subject-source_telephone-email_recontact_yes two.pdf Other-Survey
DS-PSS Generic Clearance Submission Template.doc Quality Assessment - Generic Clearance Submission IC Document

Information Collection (IC) Details

IC Title:	Quality Assessment Survey	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-Survey	1_QA Survey_ main.pdf	Yes	Yes	Fillable Fileable
Other-Survey - 2	2_QA Survey_subject v source.pdf	Yes	Yes	Fillable Fileable
Other-Survey - 3	3_QA Survey_subject_PA provided (Q2).pdf	Yes	Yes	Fillable Fileable
Other-Survey - 4	4_QA Survey_source_PA cited (Q2).pdf	Yes	Yes	Fillable Fileable
Other-Survey - 5	5_QA Survey_subject-source_in-person_re-contact_no.pdf	Yes	Yes	Fillable Fileable
Other-Survey - 6	6_QA Survey_subject-source_in-person_re-contact_yes.pdf	Yes	Yes	Fillable Fileable
Other-Survey - 7	7_QA Survey_subject-source_telephone-email_recontact_yes.pdf	Yes	Yes	Fillable Fileable
Other-Survey	8_QA Survey_subject-source_telephone-email_recontact_yes two.pdf	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22,500	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	22,500	22,500
Annual IC Time Burden (Hours)	1,125	1,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Quality Assessment - Generic Clearance Submission	DS-PSS Generic Clearance Submission Template.doc	10/24/2019

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