Information Collection

Portland Area Division of Environment Health Services: Customer Service Assessment.

IC 216470 under ICR 201504-0917-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Portland Area Division of Environment Health Services: Customer Service Assessment. Form and Instruction
0917-0036 Portland Area Division of Environment Health Services: C OMB No 0917-0036-21 Portland Area Division of Environmental Health Services Customer Services Assessment.pdf Form and Instruction
OMB No 0917-0036-21 Mini Supporting Statement for Portland Area DEHS Customer 5-7-13.pdf OMB No. 0917-0036, Mini-Supporting Statement for Portland Area Division of Environment Health Services: Customer Service Assessm IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Portland Area Division of Environment Health Services: Customer Service Assessment.	Agency IC Tracking Number:	21

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	Portland Area Division of Environment Health Services: Customer Service Assessment.	OMB No 0917-0036-21 Portland Area Division of Environmental Health Services Customer Services Assessment.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No. 0917-0036, Mini-Supporting Statement for Portland Area Division of Environment Health Services: Customer Service Assessment.	OMB No 0917-0036-21 Mini Supporting Statement for Portland Area DEHS Customer 5-7-13.pdf	05/07/2015

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