User feedback for the Benefit Cliff Calculator

Fast Track 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⚠️ Notice: This information collection may be referencing outdated material.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 0990-0379 can be found here:

Documents and Forms

Document Name Document Type
0990-0379 FT GENERIC MTRC Tool Survey 11-2-20 CLEAN.docx Other-Survey
0990-0379 MEMO_FastTrack Generic Clearance Submission MTR calculator 11-3-20.docx memo IC Document

Information Collection (IC) Details

IC Title:	User feedback for the Benefit Cliff Calculator	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			0990-0379 FT GENERIC MTRC Tool Survey 11-2-20 CLEAN.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
memo	0990-0379 MEMO_FastTrack Generic Clearance Submission MTR calculator 11-3-20.docx	11/04/2020

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