American Customer Satisfaction Index "Customer Satisfaction Surveys"

Forms and Documents

Document Name	Status
Form 100 2020 100 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 10.13.20 Form and Instruction	New
Form 101 2020 101 ARC Website Questionnaire - Final to OMB_rev Form and Instruction	New
Form 042 2020 042 CFPB_Pubs_Customer Satisfaction Survey vFINAL Form and Instruction	New
Form 027 2020 027 Shopping Bag Feedback survey mapping file Form and Instruction	New
Form 026 2020 026 DeCA Store Purchaser Survey Questions 05.14.2020 Form and Instruction	New
Form 150-20918 A0 USDA NASS Customer Satisfaction Survery-20918 A0 Form and Instruction	New
Form 149-22002 Dept of Ed Grantee Survey Program 70 Form and Instruction	New
Form 148-22002 Dept of Ed Grantee Survey Program 69 Form and Instruction	New
Form 147-22002 Dept of Ed Grantee Survey Program 68 Form and Instruction	New
Form 146-67 Dept of Ed Grantee Survey Program 67 Form and Instruction	New
Form 145-22002 Dept of Ed Grantee Survey Program 66 Form and Instruction	New
Form 144-22002 Dept of Ed Grantee Survey Program 65 Form and Instruction	New
Form 143-22002 Dept of Ed Grantee Survey Program 64 Form and Instruction	New
Form 142-22002 Dept of Ed Grantee Survey Program 63 Form and Instruction	New
Form 141-22002 Dept of Ed Grantee Survey Program 62 Form and Instruction	New
Form 140-22002 Dept of Ed Grantee Survey Program 61 Form and Instruction	New
Form 139-22002 Dept of Ed Grantee Survey Program 60 Form and Instruction	New
Form 138-22002 Dept of Ed Grantee Survey Program 59 Form and Instruction	New
Form 137-22002 Dept of Ed Grantee Survey Program 58 Form and Instruction	New
Form 136-22002 Dept of Ed Grantee Survey Program 57 Form and Instruction	New
Form 135-22002 Dept of Ed Grantee Survey Program 56 Form and Instruction	New
Form 134-22002 Dept of Ed Grantee Survey Program 55 Form and Instruction	New
Form 133-22002 Dept of Ed Grantee Survey Program 54 Form and Instruction	New
Form 132-22002 Dept of Ed Grantee Survey Program 53 Form and Instruction	New
Form 131-22002 Dept of Ed Grantee Survey Program 52 Form and Instruction	New
Form 130-22002 Dept of Ed Grantee Survey Program Form and Instruction	New
Form 129-22002 Dept of Ed Grantee Survey Program 50 Form and Instruction	New
Form 128-22002 Dept of Ed Grantee Survey Program 49 Form and Instruction	New
Form 127-22002 Dept of Ed Grantee Survey Program 48 Form and Instruction	New
Form 126-22002 Dept of Ed Grantee Survey Program 47 Form and Instruction	New
Form 125-22002 Department of Ed Grantee Survey Program 46 Form and Instruction	New
Form 124-22002 Dept of Ed Grantee Survey Program 45 Form and Instruction	New
Form 123-22002 Dept of Ed Grantee Survey Program 44 Form and Instruction	New
Form 122-22002 Dept of Ed Grantee Survey Program 43 Form and Instruction	New
Form 121-22002 Dept of Ed Grantee Survey Program 42 Form and Instruction	New
Form 120-22002 Dept of Ed Grantee Survey Program 41 Form and Instruction	New
Form 099 22002 099 22002 Dept of ED OGA Grantee Questionnaire_CORE+Tribally Controlled Colleges and Universities(20) Form and Instruction	New
Form 098 22002 098 22002 Dept of ED OGA Grantee Questionnaire_CORE+Promoting Post Baccalaureate Opportunities(19) Form and Instruction	New
Form 097 22002 097 22002 Dept of ED OGA Grantee Questionnaire_CORE+Developing Hispanic Serving Institutions(18) Form and Instruction	New
Form 096 22002 096 22002 Dept of ED OGA Grantee Questionnaire_CORE+Minority Science and Engineering(17) Form and Instruction	New
Form 095 22002 095 22002 Dept of ED OGA Grantee Questionnaire_CORE+Alaskan Native and Native Hawaiian-Part A(16) Form and Instruction	New
Form 094 22002 094 22002 Dept of ED OGA Grantee Questionnaire_CORE+Strengthening Institutions Program(15) Form and Instruction	New
Form 093 22002 093 22002 Dept of ED OGA Grantee Questionnaire_CORE+Childcare Access Means Parents In School(14) Form and Instruction	New
Form 092 22002 092 22002 Dept of ED OGA Grantee Questionnaire_CORE+GEAR UP-Partnerships(13) Form and Instruction	New
Form 119-22002 Dept of Ed Grantee Survey Program 40 Form and Instruction	New
Form 091 22002 091 22002 Dept of ED OGA Grantee Questionnaire_CORE+GEAR UP-State(12) Form and Instruction	New
Form 118-22002 Dept of Ed Grantee Survey Program 39 Form and Instruction	New
Form 090 22002 090 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA National Centers(11) Form and Instruction	New
Form 117-22002 Dept of Ed Grantee Survey Program 38 Form and Instruction	New
Form 089 22002 089 22002 Dept of ED OGA Grantee Questionnaire_CORE+Rehabilitation Long Term Training Program(10) Form and Instruction	New
Form 116-22002 Dept of Ed Grantee Survey Program 37 Form and Instruction	New
Form 088 22002 088 22002 Dept of ED OGA Grantee Questionnaire_CORE+RSA Vocational Rehabilitation Program(9) Form and Instruction	New
Form 115-22002 Dept of Ed Grante Survey Program 36 Form and Instruction	New
Form 114-22002 Dept of Ed Grantee Survey Program 35 Form and Instruction	New
Form 113-22002 Dept of Ed Grantee Survey - Program 113 Form and Instruction	New
Form 112-22002 Dept of Ed Grantee Survey Program 33 Form and Instruction	New
Form 111-22002 Dept of Ed Grantee Survey Program 32 Form and Instruction	New
Form 110-22002 Dept of Ed Grantee Survey -Program 31 Form and Instruction	New
Form 087 22002 087 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA-Part C Infants and Toddlers(8) Form and Instruction	New
Form 086 22002 086 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA-State Directors of Education(7) Form and Instruction	New
Form 109-22002 Dept of Ed Grantee Survey Program 30 Form and Instruction	New
Form 085 22002 085 22002 Dept of ED OGA Grantee Questionnaire_CORE+Native American Career and Technical Education(6) Form and Instruction	New
Form 084 22002 084 22002 Dept of ED OGA Grantee Questionnaire_CORE+Native Hawaiian Career and Technical Education(5) Form and Instruction	New
Form 108-22002 Dept of Ed Grantee Survey Program 29 Form and Instruction	New
Form 083 22002 083 22002 Dept of ED OGA Grantee Questionnaire_CORE+Carl Perkins Career&Technical(4) Form and Instruction	New
Form 082 22002 082 22002Dept of ED OGA Grantee Questionnaire_CORE+Adult Ed and Family Literacy(3) Form and Instruction	New
Form 107-22002 Dept of Ed Grantee Survey Program 28 Form and Instruction	New
Form 081 22002 OMB Mapping Cover_ED Grantee 2020_02 Form and Instruction	New
Form 106-22002 Dept of Ed Grantee Survey - Program 27 Form and Instruction	New
Form 106-22002 Dept of Ed Grantee Survey Program 26 Form and Instruction	New
Form 080-22002 Department of ED Grantee Survey program 01 Form and Instruction	New
Form 104-22002 Dept of Ed Grantee Survey- Program 25 Form and Instruction	New
Form 103-22002 Dept of Ed Grantee Survey - Program 24 Form and Instruction	New
Form 102-22002 Dept of Ed Grantee Survey- Program 23 Form and Instruction	New
Form 101-22002 101 Dept of Ed Grantee Survey Program 22 Form and Instruction	New
Form 100-22002 Department of Ed. Grantee Survey Program 21 Form and Instruction	New
Form 079-20907 A0 DOI OST Survey 20907 A0 Form and Instruction	New
Form 078-22002 A0 Dept. of Educatuon OGA Grantee Survey-22002 A0 Form and Instruction	New
Form 077-20909 A0 USDA NAL NISIC Survey #4-20909 A0 Form and Instruction	New
Form 076-20909 A0 USDA NAL Questionnaire-20909 A0 Form and Instruction	New
Form 975-20903 A0 DOJ COPS Customer Satisfaction Survey-20903 A0 Form and Instruction	New
Form 074-20923 A0 VA VHA Spina Bifida Survey #2-20923 Form and Instruction	New
Form 073-20923A0 VA VHA CHAMPVA Beneficiaries Survey #1-20923 A0 Form and Instruction	New
Form 072-20901 A0 NASA Planetary Data System Survey-20901A0 Form and Instruction	New
Form 071-20909A0 USDA NAL Survey #3-071-20909A0 Form and Instruction	New
Form 068-20905 A0 rev National Weather Service (NWS) 20905 A0 rev Form and Instruction	New
Form 070-20209 A4 2019 ED NCES Survey Form and Instruction	New
Form 069-20909A0 USDA NAL (Office of Comm) Survey #2-20909A0 Form and Instruction	New
Form 067-20909A0 USDA NAL Questionnaire 20909A0 Form and Instruction	New
Form 066-20917 A1 OCS LIHEAP Satisfaction Survey 20917 A1 Form and Instruction	New
Form 065-20328 A1 SBA Lenders Satisfaction Survey Form and Instruction	New
Form 064-20325 A2 USCIS SAVE Customer Satisfaction Survey-064-20325 A2 Form and Instruction	New
Form 063-20914 A0 HRSA OPAE Grantee Satisfaction Survey-20914A0 Form and Instruction	New
Form 062-20910A0 CFPB Customer Satisfaction Survey-20910A0 Form and Instruction	New
Form 061-20316 A1 HRSA HAB Recipeint Questionnaire-061 20316 A1 Form and Instruction	New
Form 059-20275A5-2 SBSE ACSI Questionnaire-20275-A5-2 Form and Instruction	New
Form 230 2019 230 DeCA CCSS Store Browser 20190529_DOT 6.13.19 Form and Instruction	New
Form 051-20253 A4-rev PBGC Retiree Survey-051-20253 A4-rev Form and Instruction	New
Form 052-20908 A0 DOI OSTCall Center Survey-052-20908 A0 Form and Instruction	New
Form 049-20267-A5-3 Dept of Ed CFO Grantee Customer Satisfaction Survey-20267 A5-3 Form and Instruction	New
Form 050-20265 A5 FinCEN Foreign FIU Survey-050-20265 A5 Form and Instruction	New
Form 048-20265 A5 FinCEN Products and Services Survey-20265 A5 Form and Instruction	New
Form 047-20265 A5 FinCEN Portal & Query Survey - 20265 A5 Form and Instruction	New
Form 046-20226A3 VA NCA Survey - 20226A3 Form and Instruction	New
Form 045-20265A5 FinCEN E-Filing Survey -20265A5 Form and Instruction	New
Form 044 VA VBA Life Insurance Satisfaction Questionnaire -20266 A2 Form and Instruction	New
Form 043 FEMA HMA Grant Survey (20311 A1) Form and Instruction	New
Form 042 PBGC Premium Filer Questionnaire Form and Instruction	New
Form 040 HHS OCS CED Survey Form and Instruction	New
Form 039 HRSA NHSC Site Survey Form and Instruction	New
Form 041 2019 041 PBGC Participant Caller Customer Satisfaction Survey Form and Instruction	New
Form 038 VHA Outpatient Customer Satisfaction Survey Form and Instruction	New
Form 037 VHA Inpatient Customer Satisfaction Survey Form and Instruction	New
Form 029-50165A3 2019 029 FTC Continuous Form and Instruction	New
Form 031-2048A4 2019 031 US Mint IVR Continuous Form and Instruction	New
Form 028-20320A1 2019 028 Benefits.gov Webmonitor Form and Instruction	New
Form 10-20325 A0 ACSI 2019 10 USCIS Welcome to US Pamphlet Survey Form and Instruction	New
Form 024-20261A2 2019 024 AMS Market News 2018 Form and Instruction	New
Form NWS FY18 PopupAurv 2019 015 NWS Webmonitor Form and Instruction	New
Form 014-30531 A6 ACSi 2019 014 NRRS Continuous Form and Instruction	New
Form 027-20277 A3 2019 027 NIH NIAID Webmonitor Form and Instruction	New
Form 036-20274 A3 2019 036 PBGC Participants Form and Instruction	New
Form 037-20325 A2 2019 036 USCIS E-Verify CCO Form and Instruction	New
Form 022-20313 A1 FAA Website Questionnaire 2018-19-20313 A1 Form and Instruction	New
Form 022(2)-20313 A1 ACSI Survey 2019 022 FAA FSS (Phone) Form and Instruction	New
Form 007-20327 A0 2018 007 Questionnaire_NPS.gov Form and Instruction	New
Form 005-20321 A0 2018 005 VA MOVE! Patient Experience Survey 2018 Form and Instruction	New
Form 018-30614 A4 USDA FSIS Call Center Questionnaire-30614 A4 Form and Instruction	New
Form 021-20318 A1 USGS Webmonitor Survey-021-20318 A1 Form and Instruction	New
Form 023-20317 A1 (2) ACSI Survey HRSA BHW NURSE Corps Form and Instruction	New
Form 023-20317 A1 HRSA HHS NHSC Participant Stakeholder Form and Instruction	New
Form 035-20260 A1 OSEOD Customer Touch Survey-035-20260 A3 Form and Instruction	New
Form 019-20272 A3 Dept of Ed Call Center Questionnaire Form and Instruction	New
Form 20322-A1 BCA Passport IVR Call Center Survey Form and Instruction	New
Form 025 NASA EOSDIS Survey Form and Instruction	New
Form 022 BCA Passport Annual Survey Form and Instruction	New
Form 024 NASA DEVELOP Participant Questionnaire - Survey 2 Form and Instruction	New
Form 023 NASA DEVELOP End User Questionnaire - Survey #1 Form and Instruction	New
Form 021 USCIS SAVE Call Center Survey Form and Instruction	New
Form 020 HRSA BPHC 2018 Stakeholder Satisfaction Survey Form and Instruction	New
1090-0007 Survey Mapping Document.docx Supplementary Document	2018-09-17
1090-0007 Generic Clearance Request Form 09132018.pdf Supplementary Document	2018-09-13
SS_for_1090-0007_Part_A_ 09-13-18 Final.doc Supporting Statement A	2018-09-13
SS_for_1090-0007_Part_B_05-18-2018.doc Supporting Statement B	2018-05-31
1090-0007 Published 30 Day Notice - 83 FR 25040.pdf Supplementary Document	2018-05-31
Published 60 Day Notice - 83 FR 9022.pdf Supplementary Document	2018-05-21
OVERVIEW OF THE ACSI BENCHMARK_3-5-13.doc Supplementary Document	2013-03-05
GUIDELINES PROVIDED TO AGENCIES.doc Supplementary Document	2013-02-20
E._O._13571_Streamlining_Service_Delivery_and_Improving_Customer_Service[1].doc Supplementary Document	2012-09-14
CFI_ACSI Methodology.pdf Supplementary Document	2009-08-14
ACSI Methodology Paper.pdf Supplementary Document	2009-08-13
CTA Comparison for OMB.pdf Supplementary Document	2009-08-10
E.O. 12,862.htm Supplementary Document	2009-08-05
E.O. 13,450.pdf Supplementary Document	2009-08-05
Government Performance Results Act of 1993.pdf Supplementary Document	2009-08-05

IC Document Collections

IC ID	Document Title	Status
244676	2020 100 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 10.13.20 Form and Instruction	New
244567	2020 101 ARC Website Questionnaire - Final to OMB_rev Form and Instruction	New
244429	2020 042 CFPB_Pubs_Customer Satisfaction Survey vFINAL Form and Instruction	New
242336	2020 027 Shopping Bag Feedback survey mapping file Form and Instruction	New
242225	2020 026 DeCA Store Purchaser Survey Questions 05.14.2020 Form and Instruction	New
240907	USDA NASS Customer Satisfaction Survery-20918 A0 Form and Instruction	New
240505	Dept of Ed Grantee Survey Program 70 Form and Instruction	New
240504	Dept of Ed Grantee Survey Program 69 Form and Instruction	New
240502	Dept of Ed Grantee Survey Program 68 Form and Instruction	New
240500	Dept of Ed Grantee Survey Program 67 Form and Instruction	New
240497	Dept of Ed Grantee Survey Program 66 Form and Instruction	New
240496	Dept of Ed Grantee Survey Program 65 Form and Instruction	New
240495	Dept of Ed Grantee Survey Program 64 Form and Instruction	New
240494	Dept of Ed Grantee Survey Program 63 Form and Instruction	New
240492	Dept of Ed Grantee Survey Program 62 Form and Instruction	New
240491	Dept of Ed Grantee Survey Program 61 Form and Instruction	New
240489	Dept of Ed Grantee Survey Program 60 Form and Instruction	New
240488	Dept of Ed Grantee Survey Program 59 Form and Instruction	New
240487	Dept of Ed Grantee Survey Program 58 Form and Instruction	New
240486	Dept of Ed Grantee Survey Program 57 Form and Instruction	New
240485	Dept of Ed Grantee Survey Program 56 Form and Instruction	New
240482	Dept of Ed Grantee Survey Program 55 Form and Instruction	New
240479	Dept of Ed Grantee Survey Program 54 Form and Instruction	New
240474	Dept of Ed Grantee Survey Program 53 Form and Instruction	New
240468	Dept of Ed Grantee Survey Program 52 Form and Instruction	New
240464	Dept of Ed Grantee Survey Program Form and Instruction	New
240460	Dept of Ed Grantee Survey Program 50 Form and Instruction	New
240456	Dept of Ed Grantee Survey Program 49 Form and Instruction	New
240450	Dept of Ed Grantee Survey Program 48 Form and Instruction	New
240446	Dept of Ed Grantee Survey Program 47 Form and Instruction	New
240441	Department of Ed Grantee Survey Program 46 Form and Instruction	New
240438	Dept of Ed Grantee Survey Program 45 Form and Instruction	New
240437	Dept of Ed Grantee Survey Program 44 Form and Instruction	New
240435	Dept of Ed Grantee Survey Program 43 Form and Instruction	New
240430	Dept of Ed Grantee Survey Program 42 Form and Instruction	New
240424	Dept of Ed Grantee Survey Program 41 Form and Instruction	New
240421	099 22002 Dept of ED OGA Grantee Questionnaire_CORE+Tribally Controlled Colleges and Universities(20) Form and Instruction	New
240418	098 22002 Dept of ED OGA Grantee Questionnaire_CORE+Promoting Post Baccalaureate Opportunities(19) Form and Instruction	New
240414	097 22002 Dept of ED OGA Grantee Questionnaire_CORE+Developing Hispanic Serving Institutions(18) Form and Instruction	New
240412	096 22002 Dept of ED OGA Grantee Questionnaire_CORE+Minority Science and Engineering(17) Form and Instruction	New
240408	095 22002 Dept of ED OGA Grantee Questionnaire_CORE+Alaskan Native and Native Hawaiian-Part A(16) Form and Instruction	New
240407	094 22002 Dept of ED OGA Grantee Questionnaire_CORE+Strengthening Institutions Program(15) Form and Instruction	New
240406	093 22002 Dept of ED OGA Grantee Questionnaire_CORE+Childcare Access Means Parents In School(14) Form and Instruction	New
240405	092 22002 Dept of ED OGA Grantee Questionnaire_CORE+GEAR UP-Partnerships(13) Form and Instruction	New
240404	Dept of Ed Grantee Survey Program 40 Form and Instruction	New
240403	091 22002 Dept of ED OGA Grantee Questionnaire_CORE+GEAR UP-State(12) Form and Instruction	New
240402	Dept of Ed Grantee Survey Program 39 Form and Instruction	New
240398	090 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA National Centers(11) Form and Instruction	New
240397	Dept of Ed Grantee Survey Program 38 Form and Instruction	New
240396	089 22002 Dept of ED OGA Grantee Questionnaire_CORE+Rehabilitation Long Term Training Program(10) Form and Instruction	New
240395	Dept of Ed Grantee Survey Program 37 Form and Instruction	New
240394	088 22002 Dept of ED OGA Grantee Questionnaire_CORE+RSA Vocational Rehabilitation Program(9) Form and Instruction	New
240392	Dept of Ed Grante Survey Program 36 Form and Instruction	New
240391	Dept of Ed Grantee Survey Program 35 Form and Instruction	New
240390	Dept of Ed Grantee Survey - Program 113 Form and Instruction	New
240389	Dept of Ed Grantee Survey Program 33 Form and Instruction	New
240388	Dept of Ed Grantee Survey Program 32 Form and Instruction	New
240381	Dept of Ed Grantee Survey -Program 31 Form and Instruction	New
240375	087 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA-Part C Infants and Toddlers(8) Form and Instruction	New
240373	086 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA-State Directors of Education(7) Form and Instruction	New
240370	Dept of Ed Grantee Survey Program 30 Form and Instruction	New
240368	085 22002 Dept of ED OGA Grantee Questionnaire_CORE+Native American Career and Technical Education(6) Form and Instruction	New
240367	084 22002 Dept of ED OGA Grantee Questionnaire_CORE+Native Hawaiian Career and Technical Education(5) Form and Instruction	New
240366	Dept of Ed Grantee Survey Program 29 Form and Instruction	New
240365	083 22002 Dept of ED OGA Grantee Questionnaire_CORE+Carl Perkins Career&Technical(4) Form and Instruction	New
240364	082 22002Dept of ED OGA Grantee Questionnaire_CORE+Adult Ed and Family Literacy(3) Form and Instruction	New
240363	Dept of Ed Grantee Survey Program 28 Form and Instruction	New
240360	OMB Mapping Cover_ED Grantee 2020_02 Form and Instruction	New
240358	Dept of Ed Grantee Survey - Program 27 Form and Instruction	New
240352	Dept of Ed Grantee Survey Program 26 Form and Instruction	New
240301	Department of ED Grantee Survey program 01 Form and Instruction	New
240163	Dept of Ed Grantee Survey- Program 25 Form and Instruction	New
240162	Dept of Ed Grantee Survey - Program 24 Form and Instruction	New
240160	Dept of Ed Grantee Survey- Program 23 Form and Instruction	New
240159	101 Dept of Ed Grantee Survey Program 22 Form and Instruction	New
240153	Department of Ed. Grantee Survey Program 21 Form and Instruction	New
239997	DOI OST Survey 20907 A0 Form and Instruction	New
239693	Dept. of Educatuon OGA Grantee Survey-22002 A0 Form and Instruction	New
239394	USDA NAL NISIC Survey #4-20909 A0 Form and Instruction	New
239292	USDA NAL Questionnaire-20909 A0 Form and Instruction	New
239286	DOJ COPS Customer Satisfaction Survey-20903 A0 Form and Instruction	New
239083	VA VHA Spina Bifida Survey #2-20923 Form and Instruction	New
239002	VA VHA CHAMPVA Beneficiaries Survey #1-20923 A0 Form and Instruction	New
238987	NASA Planetary Data System Survey-20901A0 Form and Instruction	New
238779	USDA NAL Survey #3-071-20909A0 Form and Instruction	New
238686	National Weather Service (NWS) 20905 A0 rev Form and Instruction	New
238685	2019 ED NCES Survey Form and Instruction	New
238393	USDA NAL (Office of Comm) Survey #2-20909A0 Form and Instruction	New
238252	USDA NAL Questionnaire 20909A0 Form and Instruction	New
237890	OCS LIHEAP Satisfaction Survey 20917 A1 Form and Instruction	New
237482	SBA Lenders Satisfaction Survey Form and Instruction	New
237481	USCIS SAVE Customer Satisfaction Survey-064-20325 A2 Form and Instruction	New
237374	HRSA OPAE Grantee Satisfaction Survey-20914A0 Form and Instruction	New
237239	CFPB Customer Satisfaction Survey-20910A0 Form and Instruction	New
237238	HRSA HAB Recipeint Questionnaire-061 20316 A1 Form and Instruction	New
236489	SBSE ACSI Questionnaire-20275-A5-2 Form and Instruction	New
236477	2019 230 DeCA CCSS Store Browser 20190529_DOT 6.13.19 Form and Instruction	New
236246	PBGC Retiree Survey-051-20253 A4-rev Form and Instruction	New
236128	DOI OSTCall Center Survey-052-20908 A0 Form and Instruction	New
235994	Dept of Ed CFO Grantee Customer Satisfaction Survey-20267 A5-3 Form and Instruction	New
235464	FinCEN Foreign FIU Survey-050-20265 A5 Form and Instruction	New
235401	FinCEN Products and Services Survey-20265 A5 Form and Instruction	New
235400	FinCEN Portal & Query Survey - 20265 A5 Form and Instruction	New
235314	VA NCA Survey - 20226A3 Form and Instruction	New
235274	FinCEN E-Filing Survey -20265A5 Form and Instruction	New
235090	VA VBA Life Insurance Satisfaction Questionnaire -20266 A2 Form and Instruction	New
235089	FEMA HMA Grant Survey (20311 A1) Form and Instruction	New
234855	PBGC Premium Filer Questionnaire Form and Instruction	New
234776	HHS OCS CED Survey Form and Instruction	New
234775	HRSA NHSC Site Survey Form and Instruction	New
234713	2019 041 PBGC Participant Caller Customer Satisfaction Survey Form and Instruction	New
233481	VHA Outpatient Customer Satisfaction Survey Form and Instruction	New
233480	VHA Inpatient Customer Satisfaction Survey Form and Instruction	New
233398	2019 029 FTC Continuous Form and Instruction	New
233397	2019 031 US Mint IVR Continuous Form and Instruction	New
233396	2019 028 Benefits.gov Webmonitor Form and Instruction	New
233395	ACSI 2019 10 USCIS Welcome to US Pamphlet Survey Form and Instruction	New
233394	2019 024 AMS Market News 2018 Form and Instruction	New
233393	2019 015 NWS Webmonitor Form and Instruction	New
233392	ACSi 2019 014 NRRS Continuous Form and Instruction	New
233391	2019 027 NIH NIAID Webmonitor Form and Instruction	New
233390	2019 036 PBGC Participants Form and Instruction	New
233389	2019 036 USCIS E-Verify CCO Form and Instruction	New
233388	FAA Website Questionnaire 2018-19-20313 A1 Form and Instruction	New
233387	ACSI Survey 2019 022 FAA FSS (Phone) Form and Instruction	New
233386	2018 007 Questionnaire_NPS.gov Form and Instruction	New
233385	2018 005 VA MOVE! Patient Experience Survey 2018 Form and Instruction	New
233384	USDA FSIS Call Center Questionnaire-30614 A4 Form and Instruction	New
233383	USGS Webmonitor Survey-021-20318 A1 Form and Instruction	New
233382	ACSI Survey HRSA BHW NURSE Corps Form and Instruction	New
233381	HRSA HHS NHSC Participant Stakeholder Form and Instruction	New
233380	OSEOD Customer Touch Survey-035-20260 A3 Form and Instruction	New
233379	Dept of Ed Call Center Questionnaire Form and Instruction	New
233378	BCA Passport IVR Call Center Survey Form and Instruction	New
233180	NASA EOSDIS Survey Form and Instruction	New
233147	BCA Passport Annual Survey Form and Instruction	New
233146	NASA DEVELOP Participant Questionnaire - Survey 2 Form and Instruction	New
233145	NASA DEVELOP End User Questionnaire - Survey #1 Form and Instruction	New
233073	USCIS SAVE Call Center Survey Form and Instruction	New
233060	HRSA BPHC 2018 Stakeholder Satisfaction Survey Form and Instruction	New

ICR Details

OMB Control No: 1090-0007	ICR Reference No: 201805-1090-002
Status: Active	Previous ICR Reference No: 201412-1090-003
Agency/Subagency: DOI/ASPMB	Agency Tracking No: 1090-0007
Title: American Customer Satisfaction Index "Customer Satisfaction Surveys"
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/17/2018
	Date Received in OIRA: 07/27/2018
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), complete the Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) the agency must complete the Survey Mapping Template to allow for a cross comparison of survey questions with the survey question bank.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2021	36 Months From Approved	09/30/2018
Responses	80,000	0	240,000
Time Burden (Hours)	16,000	0	48,000
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a request for a a three-year extension of the generic clearance to conduct customer satisfaction measures of Federal Government programs and services utilizing the methodology of the American Customer Satisfaction Index (ACSI). This extension will allow for continued use of a data-driven, statistically valid approach to understanding customer satisfaction with agency interactions and processes. By using the ACSI methodology, agencies gain important insights about who their customers are and what specifically drives their satisfaction. This allows decision-makers to objectively measure their processes and/or service delivery and use the results to allocate resources more effectively. The ultimate objective is to help agencies become more citizen-centric and achieve higher levels of citizen trust and confidence.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
   EO: EO 13571 Name/Subject of EO: Streamlining Service Delivery and Improving Customer Service
   EO: EO 13450 Name/Subject of EO: Improving Government Program Performance
   US Code: 31 USC 1116 Name of Law: Government Performance Results Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 9022	03/02/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 25040	05/31/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 140

IC Title	Form No.	Form Name
2019 041 PBGC Participant Caller Customer Satisfaction Survey	041	PBGC Participant Caller Customer Satisfaction
BCA Passport Annual Survey	022	BCA Passport Annual Survey
Dept of Ed Grantee Survey - Program 24	103-22002	Dept of Ed Grantee Survey-Program 24
HRSA HAB Recipeint Questionnaire-061 20316 A1	061-20316 A1	HRSA HAB Recipient Questionnaire
FinCEN Foreign FIU Survey-050-20265 A5	050-20265 A5	FinCEN Foreign FIU Survey-050-20265 A5
VHA Inpatient Customer Satisfaction Survey	037	NHA inpatient Customer Satisfaction Survey
2019 036 USCIS E-Verify CCO	037-20325 A2	USCIS E-Verify CCO Survey-20325 A2
2019 027 NIH NIAID Webmonitor	027-20277 A3	NIH NIAID Survey
HRSA HHS NHSC Participant Stakeholder	023-20317 A1	NHSC HRSA Participant Survey-023-20317 A1
Dept of Ed Grantee Survey Program 62	141-22002	Dept of Ed Grantee Survey Program 62
082 22002Dept of ED OGA Grantee Questionnaire_CORE+Adult Ed and Family Literacy(3)	082 22002	082 22002Dept of ED OGA Grantee Questionnaire_CORE+Adult Ed and Family Literacy(3)
VA VHA CHAMPVA Beneficiaries Survey #1-20923 A0	073-20923A0	VA VHA CHAMPVA Beneficiaries Survey #1-20923 A0
USDA NAL Questionnaire-20909 A0	076-20909 A0	USDA NAL Questionnaire
Dept of Ed Grantee Survey Program 56	135-22002	Dept of Ed Grantee Survey Program 56
089 22002 Dept of ED OGA Grantee Questionnaire_CORE+Rehabilitation Long Term Training Program(10)	089 22002	089 22002 Dept of ED OGA Grantee Questionnaire_CORE+Rehabilitation Long Term Training Program(10)
Dept of Ed Grantee Survey Program 61	140-22002	Dept of Ed Grantee Survey Program 61
085 22002 Dept of ED OGA Grantee Questionnaire_CORE+Native American Career and Technical Education(6)	085 22002	085 22002 Dept of ED OGA Grantee Questionnaire_CORE+Native American Career and Technical Education(6)
Dept of Ed Grantee Survey Program 55	134-22002	Dept of Ed Grantee Survey Program 55
Dept of Ed Grantee Survey Program 26	106-22002	Dept of Ed Grantee Survey Program 26
Dept of Ed Grantee Survey Program 40	119-22002	Dept of Ed Grantee Survey Program 119
Dept of Ed Grantee Survey -Program 31	110-22002	Dept of Ed Grantee Survey Program 31
USDA NAL (Office of Comm) Survey #2-20909A0	069-20909A0	USDA NAL (Office of Comm) Survey #2-20909A0
Department of Ed. Grantee Survey Program 21	100-22002	Dept of Ed. Survey Program 21
NASA Planetary Data System Survey-20901A0	072-20901 A0	NASA Planetary Data System Survey
088 22002 Dept of ED OGA Grantee Questionnaire_CORE+RSA Vocational Rehabilitation Program(9)	088 22002	088 22002 Dept of ED OGA Grantee Questionnaire_CORE+RSA Vocational Rehabilitation Program(9)
Dept of Ed Grantee Survey Program 50	129-22002	Dept of Ed Grantee Survey Program 50
Dept of Ed Grantee Survey - Program 27	106-22002	Dept of Ed Grantee Survey Program 27
ACSI Survey 2019 022 FAA FSS (Phone)	022(2)-20313 A1	FAA FSS Phone Survey-022(2)-20313 A1
National Weather Service (NWS) 20905 A0 rev	068-20905 A0 rev	National Weather Service (NWS) Survey
Dept of Ed Grantee Survey Program 57	136-22002	Dept of Ed Grantee Survey Program 57
VA VHA Spina Bifida Survey #2-20923	074-20923 A0	VA VHA Spins Bifida Survey #2-20923
Dept of Ed Grantee Survey Program 35	114-22002	Dept of Ed Grantee Survey Program 35
Dept of Ed Grantee Survey Program 49	128-22002	Dept of Ed Grantee Survey Program 49
094 22002 Dept of ED OGA Grantee Questionnaire_CORE+Strengthening Institutions Program(15)	094 22002	094 22002 Dept of ED OGA Grantee Questionnaire_CORE+Strengthening Institutions Program(15)
DOI OST Survey 20907 A0	079-20907 A0	DOI OST Survey
Dept of Ed Grantee Survey- Program 23	102-22002	Dept of Ed Grantee Survey Program 23
NASA DEVELOP End User Questionnaire - Survey #1	023	NASA DEVELOP End User Questionnaire - Survey #1
Department of Ed Grantee Survey Program 46	125-22002	Dept of Ed Grantee Survey Program 46
Dept of Ed Grantee Survey Program 39	118-22002	Dept of Ed Grantee Survey Program 39
BCA Passport IVR Call Center Survey	20322-A1	BCA Passport IVR Call Center Survey
2018 007 Questionnaire_NPS.gov	007-20327 A0	NPS.gov Webmonitor-007-20327
FAA Website Questionnaire 2018-19-20313 A1	022-20313 A1	FAA Website Questionnaire-20313 A1
ACSi 2019 014 NRRS Continuous	014-30531 A6	NRRS Customer Service Survey -30531 A6
ACSI 2019 10 USCIS Welcome to US Pamphlet Survey	10-20325 A0	USCIS Welcome to US Pamphlet Survey-20325 A0
OSEOD Customer Touch Survey-035-20260 A3	035-20260 A1	OSEOD Customer Touch Survey
DOI OSTCall Center Survey-052-20908 A0	052-20908 A0	DOI OST Call Center Survey
USCIS SAVE Customer Satisfaction Survey-064-20325 A2	064-20325 A2	USCIS SAVE Customer Satifaction Survey
SBA Lenders Satisfaction Survey	065-20328 A1	SBA Lenders Satisfaction Survey
Dept of Ed Grantee Survey Program 37	116-22002	Dept of Ed Grantee Survey Program 37
083 22002 Dept of ED OGA Grantee Questionnaire_CORE+Carl Perkins Career&Technical(4)	083 22002	083 22002 Dept of ED OGA Grantee Questionnaire_CORE+Carl Perkins Career&Technical(4)
Dept of Ed Grantee Survey Program	130-22002	Dept of Ed Grantee Survey Program 51
Dept of Ed Grantee Survey Program 30	109-22002	Dept of Ed Grantee Survey Program 30
084 22002 Dept of ED OGA Grantee Questionnaire_CORE+Native Hawaiian Career and Technical Education(5)	084 22002	084 22002 Dept of ED OGA Grantee Questionnaire_CORE+Native Hawaiian Career and Technical Education(5)
Dept of Ed Grantee Survey Program 58	137-22002	Dept of Ed Grantee Survey Program 58
Dept of Ed Grantee Survey Program 60	139-22002	Dept of Ed Grantee Survey Program 60
HHS OCS CED Survey	040	HHS OCS CED Survey
HRSA OPAE Grantee Satisfaction Survey-20914A0	063-20914 A0	2019 HRSA OPAE Grantee Satisfaction Survey
NASA DEVELOP Participant Questionnaire - Survey 2	024	NASA DEVELOP Participant Questionnaire - Survey 2
Dept of Ed Grantee Survey- Program 25	104-22002	Dept of Ed Grantee Survey - Program 25
2020 027 Shopping Bag Feedback survey mapping file	027	2020 027 Shopping Bag Feedback survey mapping file
VHA Outpatient Customer Satisfaction Survey	038	VHA Outpatient Customer Satisfaction Survey
2019 031 US Mint IVR Continuous	031-2048A4	US Mint Call Center (IVR) Questionnaire
Dept of Ed Grantee Survey Program 53	132-22002	Dept of Ed Grantee Survey Program 53
2019 036 PBGC Participants	036-20274 A3	PBGC Participants Survey-20274 A3
2018 005 VA MOVE! Patient Experience Survey 2018	005-20321 A0	VA MOVE! Patient Experience Survey-005-20321 A0
Dept of Ed Grantee Survey Program 68	147-22002	Dept of Ed Grantee Survey Program 68
095 22002 Dept of ED OGA Grantee Questionnaire_CORE+Alaskan Native and Native Hawaiian-Part A(16)	095 22002	095 22002 Dept of ED OGA Grantee Questionnaire_CORE+Alaskan Native and Native Hawaiian-Part A(16)
Dept of Ed Grantee Survey Program 29	108-22002	Dept of Ed Grantee Survey Program 29
Dept of Ed Grantee Survey Program 42	121-22002	Dept of Ed Grantee Survey Program 42
Dept of Ed Grantee Survey Program 67	146-67	Dept of Ed Grantee Survey Program 67
Dept of Ed Grantee Survey Program 59	138-22002	Dept of Ed Grantee Survey Program 59
Dept. of Educatuon OGA Grantee Survey-22002 A0	078-22002 A0	Dept. of Ed OGA Grantee Survey
Dept of Ed Grantee Survey Program 64	143-22002	Dept of Ed Grantee Survey Program 64
Dept of Ed Grantee Survey Program 44	123-22002	Dept of Ed Grantee Survey Program 44
2020 101 ARC Website Questionnaire - Final to OMB_rev	101	2020 101 ARC Website Questionnaire - Final to OMB_rev
2020 026 DeCA Store Purchaser Survey Questions 05.14.2020	026	2020 026 DeCA Store Purchaser Survey Questions 05.14.2020
2019 029 FTC Continuous	029-50165A3	FTC Continuous Questionnaire
PBGC Premium Filer Questionnaire	042	PBGC Premium Filer Questionnaire
091 22002 Dept of ED OGA Grantee Questionnaire_CORE+GEAR UP-State(12)	091 22002	091 22002 Dept of ED OGA Grantee Questionnaire_CORE+GEAR UP-State(12)
FinCEN Portal & Query Survey - 20265 A5	047-20265 A5	FinCEN Portal and Query Survey
Dept of Ed Grantee Survey Program 54	133-22002	Dept of Ed Grantee Survey Program 54
Dept of Ed Grantee Survey Program 41	120-22002	Dept of Ed Grantee Survey Program 41
Dept of Ed Grantee Survey Program 69	148-22002	Dept of Ed Grantee Survey Program 69
Dept of Ed Grantee Survey Program 33	112-22002	Dept of Ed Grantee Survey - Program 33
Dept of Ed Grantee Survey - Program 113	113-22002	Dept of Ed Grantee Survey Program 34
USDA NASS Customer Satisfaction Survery-20918 A0	150-20918 A0	USDA NASS Customer Satisfaction Survery
Department of ED Grantee Survey program 01	080-22002	Department of ED
HRSA NHSC Site Survey	039	HRSA NHSC Site Survey
VA VBA Life Insurance Satisfaction Questionnaire -20266 A2	044	VA VBA Life Insurance Satisfaction Questionnaire (20266 A2)
2019 230 DeCA CCSS Store Browser 20190529_DOT 6.13.19	230, 230	2019 230 DeCA CCSS Store Browser 20190529_DOT 6.13.19 ,   2019 230 DeCA Core Store Purchaser_06.13.19
Dept of Ed Grantee Survey Program 52	131-22002	Dept of Ed Grantee Survey Program 52
Dept of Ed CFO Grantee Customer Satisfaction Survey-20267 A5-3	049-20267-A5-3	Dept of Ed CFO Grantee Customer Satisfaction Survey-20267 A5-3
USDA FSIS Call Center Questionnaire-30614 A4	018-30614 A4	USDA FSIS Call Center Questionnaire-018-30614 A4
USDA NAL NISIC Survey #4-20909 A0	077-20909 A0	USDA NAL NISIC Survey-20909 A0
2019 ED NCES Survey	070-20209 A4	2019 ED NCES Survey
086 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA-State Directors of Education(7)	086 22002	086 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA-State Directors of Education(7)
Dept of Ed Grantee Survey Program 32	111-22002	Dept of Ed Grantee Survey - Program 32
OMB Mapping Cover_ED Grantee 2020_02	081 22002	081 22002Dept of ED OGA Grantee Questionnaire_CORE+National Professional Development Program(02)
Dept of Ed Grantee Survey Program 66	145-22002	Dept of Ed Grantee Survey Program 66
Dept of Ed Grantee Survey Program 65	144-22002	Dept of Ed Grantee Survey Program 65
Dept of Ed Grantee Survey Program 38	117-22002	Dept of Ed Grantee Survey Program 38
2020 042 CFPB_Pubs_Customer Satisfaction Survey vFINAL	042	2020 042 CFPB_Pubs_Customer Satisfaction Survey vFINAL
Dept of Ed Grantee Survey Program 43	122-22002	Dept of Ed Grantee Survey Program 43
CFPB Customer Satisfaction Survey-20910A0	062-20910A0	CFPB FinEx Customer Satisfaction Survey
PBGC Retiree Survey-051-20253 A4-rev	051-20253 A4-rev	PBGC Retiree Survey 051-20253 A4-rev
VA NCA Survey - 20226A3	046-20226A3	VA NCA Survey-20226A3
FEMA HMA Grant Survey (20311 A1)	043	FEMA HMA Grant Survey
HRSA BPHC 2018 Stakeholder Satisfaction Survey	020	HRSA BPHC 2018 Stakeholder Satisfaction Survey
FinCEN E-Filing Survey -20265A5	045-20265A5	FinCEN BSA E-Filing Survey-20265A5
USGS Webmonitor Survey-021-20318 A1	021-20318 A1	USGS Webmonitor Survey-021-20318 A1
OCS LIHEAP Satisfaction Survey 20917 A1	066-20917 A1	OCS LIHEAP Satisfaction Survey
Dept of Ed Grante Survey Program 36	115-22002	Dept of Ed Grantee Survey Program 36
Dept of Ed Grantee Survey Program 63	142-22002	Dept of Ed Grantee Survey Program 63
DOJ COPS Customer Satisfaction Survey-20903 A0	975-20903 A0	DOJ COPS Customer Satisfaction Survey-20903 A0
Dept of Ed Grantee Survey Program 48	127-22002	Dept of Ed Grantee Survey Program 48
2020 100 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 10.13.20	100	2020 100 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 10.13.20
Dept of Ed Grantee Survey Program 28	107-22002	Dept. of Ed Grantee Survey Program 28
097 22002 Dept of ED OGA Grantee Questionnaire_CORE+Developing Hispanic Serving Institutions(18)	097 22002	097 22002 Dept of ED OGA Grantee Questionnaire_CORE+Developing Hispanic Serving Institutions(18)
Dept of Ed Grantee Survey Program 47	126-22002	Dept of Ed Grantee Survey Program 47
USDA NAL Survey #3-071-20909A0	071-20909A0	USDA NAL Survey #3
101 Dept of Ed Grantee Survey Program 22	101-22002	101 Dept of Ed Grantee Survey Program 22
USCIS SAVE Call Center Survey	021	USCIS SAVE Call Center Survey
NASA EOSDIS Survey	025	NASA EOSDIS Survey Questionnaire
2019 015 NWS Webmonitor	NWS FY18 PopupAurvey Webmonitor	NWS FY18
096 22002 Dept of ED OGA Grantee Questionnaire_CORE+Minority Science and Engineering(17)	096 22002	096 22002 Dept of ED OGA Grantee Questionnaire_CORE+Minority Science and Engineering(17)
2019 028 Benefits.gov Webmonitor	028-20320A1	Benefits.gov Webmonitor
098 22002 Dept of ED OGA Grantee Questionnaire_CORE+Promoting Post Baccalaureate Opportunities(19)	098 22002	098 22002 Dept of ED OGA Grantee Questionnaire_CORE+Promoting Post Baccalaureate Opportunities(19)
087 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA-Part C Infants and Toddlers(8)	087 22002	087 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA-Part C Infants and Toddlers(8)
Dept of Ed Call Center Questionnaire	019-20272 A3	Dept of Ed Call Center Questionnaire-019-20272 A3
FinCEN Products and Services Survey-20265 A5	048-20265 A5	FinCEN Products and Services Survey
ACSI Survey HRSA BHW NURSE Corps	023-20317 A1 (2)	HRSA BHW Nurse Corps Participant Survey
2019 024 AMS Market News 2018	024-20261A2	USDA AMS Market News survey IA 20261
SBSE ACSI Questionnaire-20275-A5-2	059-20275A5-2	SBSE ACSI Questionnaire 20275A5-2
093 22002 Dept of ED OGA Grantee Questionnaire_CORE+Childcare Access Means Parents In School(14)	093 22002	093 22002 Dept of ED OGA Grantee Questionnaire_CORE+Childcare Access Means Parents In School(14)
090 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA National Centers(11)	090 22002	090 22002 Dept of ED OGA Grantee Questionnaire_CORE+IDEA National Centers(11)
Dept of Ed Grantee Survey Program 70	149-22002	Dept of Ed Grantee Survey Program 70
USDA NAL Questionnaire 20909A0	067-20909A0	USDA NAL Questionnaire-20909
092 22002 Dept of ED OGA Grantee Questionnaire_CORE+GEAR UP-Partnerships(13)	092 22002	092 22002 Dept of ED OGA Grantee Questionnaire_CORE+GEAR UP-Partnerships(13)
Dept of Ed Grantee Survey Program 45	124-22002	Dept of Ed Grantee Survey Program 124
099 22002 Dept of ED OGA Grantee Questionnaire_CORE+Tribally Controlled Colleges and Universities(20)	099 22002	099 22002 Dept of ED OGA Grantee Questionnaire_CORE+Tribally Controlled Colleges and Universities(20)

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	80,000	240,000	0	0	-160,000	0
Annual Time Burden (Hours)	16,000	48,000	0	0	-32,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $4,080,926

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/31/2018

---