INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-I: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display. |
TITLE OF INFORMATION COLLECTION DOCUMENT | OMB NO. | 0560-0286 | ||||||||||||||||
FSA's Qualitative Feedback on Agency Service Delivery (FSA Fast Track) | |||||||||||||||||||
DATE PREPARED | |||||||||||||||||||
October 29, 2020 | |||||||||||||||||||
IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT | ANNUAL BURDEN | ||||||||||||||||||
REPORTS | RECORDS | RESPONDENT COST | |||||||||||||||||
TOTAL BURDEN HOURS | TOTAL | ||||||||||||||||||
FORMS NO (S) | NO. OF | NO OF | TOTAL ANNUAL | HOURS | (Col. F x G) | NO. OF | ANNUAL | RECORD- | COST | TOTAL | |||||||||
SECTION OF | DESCRIPTION | (If "none" | RESPONDENTS | RESPONSES | RESPONSES | PER | (H) | RECORD- | HOURS PER | KEEPING HOURS | PER | COST | |||||||
REGS. | so state) | PER | (Col. D x E) | RESPONSE | KEEPERS | RECORD- | (Col. I x J) | HOUR | (Col. H x L) | ||||||||||
RESPONDENT | EXEMPT | NON-EXEMPT | KEEPER | ||||||||||||||||
(A) | (B) | (C) | (D) | (E) | (F) | (G) | (I) | (J) | (K) | (L) | (M) | ||||||||
eO 12862 | Customer Survey | 200,000 | 1 | 200,000 | 0.17 | 33,333 | 0 | ||||||||||||
Comment Cards | 10,000 | 1 | 10,000 | 0.25 | 2,500 | 0 | |||||||||||||
Focus group | 500 | 1 | 500 | 3.00 | 1,500 | 0 | |||||||||||||
0 | |||||||||||||||||||
SUBTOTAL | 210,500 | 0 | 37,333 | 0.00 | 0 | ||||||||||||||
TOTAL OF ALL PAGES | 210,500 | 0 | 37,333 | 0.00 | 0 | ||||||||||||||
TOTAL - COLUMNS "F" AND "I" = OMB 83-I, 13b; COLUMNS "H" AND "K" = OMB 83-I, 13c | 210,500 | 37,333 |
File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |