Enrollee Survey Round 1 (nonrespondents)

Retaining Employment and Talent After Injury/Illness Network (RETAIN) demonstration

Documents and Forms

Document Name Document Type
APPENDIX B - ENROLLEE SURVEY INSTRUMENTS (Round 1).pdf Other-ENROLLEE SURVEY INSTRUMENTS (R
APPENDIX B - ENROLLEE SURVEY INSTRUMENTS (Round 1).pdf Other-ENROLLEE SURVEY INSTRUMENTS (R
APPENDIX C - ENROLLEE SURVEY MAILINGS (Round 1).pdf Other-ENROLLEE SURVEY INSTRUMENTS (R
APPENDIX C - ENROLLEE SURVEY MAILINGS (Round 1).pdf Other-ENROLLEE SURVEY INSTRUMENTS (R

Information Collection (IC) Details

IC Title:	Enrollee Survey Round 1 (nonrespondents)	Agency IC Tracking Number:

Is this a Common Form? No		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-ENROLLEE SURVEY INSTRUMENTS (Round 1).			APPENDIX B - ENROLLEE SURVEY INSTRUMENTS (Round 1).pdf		Yes	Yes	Fillable Fileable
Other-ENROLLEE SURVEY INSTRUMENTS (Round 1)			APPENDIX C - ENROLLEE SURVEY MAILINGS (Round 1).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 468	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	468	468
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	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.