Assessment Evaluation - State Local Tribal Respondents

Program Evaluation Instruments - Environmental Conflict Resolution Services Participant Questionnaires (Five Instruments)

Documents and Forms

Document Name Document Type
Form 3320-0003 (A) Assessment Evaluation - State Local Tribal Respondents Form and Instruction
3320-0003 (A) Assessment Evaluation Assessment Evaluation - Requester Questionnaire - 0003A.pdf Form and Instruction
3320-0003 (A) Assessment Evaluation Assessment Evaluation - Requester Questionnaire - 0003A.pdf Form and Instruction
Assessment Evaluation - Requester Questionnaire - 0003A - Electronic Screen Print.pdf Screen Print of Electronic Version IC Document
Assessment Evaluation - Requester Questionnaire - 0003A - Electronic Screen Print.pdf Screen Print of Electronic Version IC Document

Information Collection (IC) Details

IC Title:	Assessment Evaluation - State Local Tribal Respondents	Agency IC Tracking Number:	0003A

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	3320-0003 (A)	Assessment Evaluation	Assessment Evaluation - Requester Questionnaire - 0003A.pdf		Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	10	-90	100
Annual IC Time Burden (Hours)	1	-7	8
Annual IC Cost Burden (Dollars)	53	53	0

Documents for IC

Title	Document	Date Uploaded
Screen Print of Electronic Version	Assessment Evaluation - Requester Questionnaire - 0003A - Electronic Screen Print.pdf	03/13/2024

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