Fiscal Year (FY) 2021 Prospective Client Survey and FY 21 National Disability Forum

Generic Clearance of Customer Satisfaction Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0526 can be found here:

Documents and Forms

Document Name Document Type
FY 2021 PCS Questionnaire.docx Other-PCS Questionnaire
FY 2021 Prospective Client Survey Schedule.docx Other-Prospective Client Survey Sche
Sample 2 - Registration Template - NDF.docx Other-Registration Template Sample F
Sample 3 - NDF Facilitator and Panelist.docx Other-NDF Facilitator and Panelist F
Sample 4 - Disability Forum Evaluation Form.docx Other-Disability Forum Evaluation Fo
Sample 5 - Engage SSA for NDF.docx Other-Sample Engage SSA for NDF FY 2
Description FY 2021 Prospective Client Survey.docx Description of Fiscal Year (FY) 2021 Prospective Client Survey IC Document
Description of National Disability Forum FY 2021.docx Description of National Disability Forum FY 2021 IC Document

Information Collection (IC) Details

IC Title:	Fiscal Year (FY) 2021 Prospective Client Survey and FY 21 National Disability Forum	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-PCS Questionnaire	FY 2021 PCS Questionnaire.docx	No		Paper Only
Other-Prospective Client Survey Schedule	FY 2021 Prospective Client Survey Schedule.docx	No		Paper Only
Other-Registration Template Sample FY 21	Sample 2 - Registration Template - NDF.docx	Yes	Yes	Fillable Fileable Signable
Other-NDF Facilitator and Panelist FY 21	Sample 3 - NDF Facilitator and Panelist.docx	No		Paper Only
Other-Disability Forum Evaluation Form FY 21	Sample 4 - Disability Forum Evaluation Form.docx	Yes	Yes	Fillable Fileable Signable
Other-Sample Engage SSA for NDF FY 21	Sample 5 - Engage SSA for NDF.docx	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 83 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,900	10,900
Annual IC Time Burden (Hours)	35,425	35,425
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Description of Fiscal Year (FY) 2021 Prospective Client Survey	Description FY 2021 Prospective Client Survey.docx	09/24/2020
Description of National Disability Forum FY 2021	Description of National Disability Forum FY 2021.docx	09/24/2020

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