Customer Survey - State, Local, or Tribal

Child Welfare Information Gateway

Documents and Forms

Document Name Document Type
Form 0970-0303 Customer Survey - State, Local, or Tribal Form
0970-0303 Appendix D_Customer Survey Appendix D_Customer Survey.doc Form

Information Collection (IC) Details

IC Title:	Customer Survey - State, Local, or Tribal	Agency IC Tracking Number:

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	0970-0303	Appendix D_Customer Survey	Appendix D_Customer Survey.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 187	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 76 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	187	-123	310
Annual IC Time Burden (Hours)	15	-9	24
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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