Information Collection

OIT Customer Satisfaction Survey - Problem Ticket

IC 204846 under ICR 201205-0917-002 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Document Name Document Type
Form 0917-0036-14 OIT Customer Satisfaction Survey - Problem Ticket Form and Instruction
0917-0036-14 OIT Customer Satisfaction Survey - Problem Ticket, OMB N OMB Form No 0917-0036-14 10_25_12.docx www.surveymonkey.com/s/P8QKDQP Form and Instruction
OMB No 0917-0036-14 OIT Customer Satisfaction Survey- Service Ticket.doc OMB No. 0917-0036-14, Mini-Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OIT Customer Satisfaction Survey - Problem Ticket	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	0917-0036-14	OIT Customer Satisfaction Survey - Problem Ticket, OMB No. 0917-0036-14	OMB Form No 0917-0036-14 10_25_12.docx	https://www.surveymonkey.com/s/P8QKDQP	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	500	0	0	0	0	0
Annual IC Time Burden (Hours)	42	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No. 0917-0036-14, Mini-Supporting Statement	OMB No 0917-0036-14 OIT Customer Satisfaction Survey- Service Ticket.doc	10/25/2012

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