2025 Area Screening Survey, a pilot study for the June Area Survey

Quick Response for Cooperator-funded Surveys Generic Clearance

Documents and Forms

Document Name Document Type
Form SurveyID 2025 Area Screening Survey, a pilot study for the June Area Survey Form and Instruction
SurveyID 2025 Area Screener NY IL TX Version 0264 - June Area Screener Pilot Questionnaire to OMB NY IL TX _v2.pdf Form and Instruction
SurveyID 2025 Area Screener CO, OR Version 0264- June Area Screener Pilot Questionnaire to OMB CO OR_v2.pdf Form and Instruction
0264 - 20XX Sample Reminder Text Message Sent to Respondents - July 08, 2025.docx 0264 - Sample Reminder Text Message Sent to Respondents IC Document
0264 - 2025 Area Sample Reminder E-Mail.docx 0264 - 2025 Area Sample Reminder E-Mail IC Document
0264 - Area Map example - 1.pdf 0264 - Area Map example - 1 IC Document
0264 - Area Map example - 2.pdf 0264 - Area Map example - 2 IC Document
0264 - Area Map example - 3.pdf 0264 - Area Map example - 3 IC Document
0264 - 2025 Area Screening Survey, a pilot study for the June Area Survey - SSB - 2025.docx 0264 - 2025 Area Screening Survey, a pilot study for the June Area Survey - SSB - 2025 IC Document
0264 - 2025 Area Screening Survey, a pilot study for the June Area Survey - SSA - 2025.docx 0264 - 2025 Area Screening Survey, a pilot study for the June Area Survey - SSA - 2025 IC Document
0264 - 2025_Area_Screening_Survey_Cover_Letter_.docx 0264 - 2025 Area Screener Survey Cover Letter IC Document

Information Collection (IC) Details

IC Title:	2025 Area Screening Survey, a pilot study for the June Area Survey	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
Form and Instruction	SurveyID	2025 Area Screener NY IL TX Version	0264 - June Area Screener Pilot Questionnaire to OMB NY IL TX _v2.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	SurveyID	2025 Area Screener CO, OR Version	0264- June Area Screener Pilot Questionnaire to OMB CO OR_v2.pdf		Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records
Title: SORN	FR Citation: 74 FR 79

Number of Respondents: 12,000	Number of Respondents for Small Entity: 10,200

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19,850	19,850
Annual IC Time Burden (Hours)	3,540	3,540
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0264 - Sample Reminder Text Message Sent to Respondents	0264 - 20XX Sample Reminder Text Message Sent to Respondents - July 08, 2025.docx	08/28/2025
0264 - 2025 Area Sample Reminder E-Mail	0264 - 2025 Area Sample Reminder E-Mail.docx	08/28/2025
0264 - Area Map example - 1	0264 - Area Map example - 1.pdf	08/28/2025
0264 - Area Map example - 2	0264 - Area Map example - 2.pdf	08/28/2025
0264 - Area Map example - 3	0264 - Area Map example - 3.pdf	08/28/2025
0264 - 2025 Area Screening Survey, a pilot study for the June Area Survey - SSB - 2025	0264 - 2025 Area Screening Survey, a pilot study for the June Area Survey - SSB - 2025.docx	08/28/2025
0264 - 2025 Area Screening Survey, a pilot study for the June Area Survey - SSA - 2025	0264 - 2025 Area Screening Survey, a pilot study for the June Area Survey - SSA - 2025.docx	08/28/2025
0264 - 2025 Area Screener Survey Cover Letter	0264 - 2025_Area_Screening_Survey_Cover_Letter_.docx	08/28/2025

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