View Information Collection (IC)

View Information Collection (IC)

IC Title:	Disability Perception Survey (DPS) - Web version	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-DPS Survey			Appendix A_DPS survey.docx		Yes	Yes	Fillable Fileable
Other-Privacy Act Satement			Appendix A2_Privacy Act Statement.docx		No		Paper Only
Other-DPS Item Justication			Appendix B DPS item justification.docx		No		Paper Only
Other-Email Invitation			Appendix C_AmeriSpeak’s Email Invitation script.docx		Yes	No	Printable Only
Other-Reminder email			Appendix E_Reminder to complete your AmeriSpeak survey.docx		Yes	No	Printable Only
Other-Friendly reminder to complete survey			Appendix F_Reminder 2_Another friendly reminder about your AmeriSpeak survey.docx		Yes	No	Printable Only
Other-Act Now reminder			Appendix G_Reminder 3_ Act now and receive 20,000 AmeriPoints.docx		Yes	No	Printable Only
Other-Survey is ending soon			Appendix H_Reminder 4_Your AmeriSpeak survey is ending soon.docx		Yes	No	Printable Only
Other-Time is runnnint out screen			Appendix I_Reminder 5_Time is running out.docx		Yes	No	Printable Only
Other-Last chance email			Appendix J_“Last Chance” email script.docx		Yes	No	Printable Only
Other-Paritial reminder to finish			Appendix K_ Partial_Reminder to Finish.docx		Yes	No	Printable Only
Other-Text message promptin script			Appendix L_AmeriSpeak’s text messaging prompting scripts.docx		Yes	Yes	Fillable Fileable
Other-Post Card			Appendix M_Post Card.docx		No		Paper Only
Other-reminder letter with $2			Appendix N_reminder letter with $2 included.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,259	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	4,259	0	4,259	0	0	0
Annual IC Time Burden (Hours)	1,207	0	1,207	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	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.