CCOE Community Partner Survey

DataCollection for the Identification ofComparisonGroups for the National Com. Ctrs of Excellencein Women's Health (CCOE) Program

Documents and Forms

Document Name Document Type
Round_II_CCOE_Eval_Meth_20061004 (2).doc Other-Other
Round_II_CCOE_CtrDirector_PC_Survey_20061020.doc Other-Other
Round_II_CCOE_Community_Partner_Survey_20061018.doc Other-Other
Round II CCOE Participant Survey_20061004.doc Other-Other
Round II_CCOE_Site_Visit_Protocol_20061020.doc Other-Other

Information Collection (IC) Details

IC Title:	CCOE Community Partner Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other	Round_II_CCOE_Eval_Meth_20061004 (2).doc	No	No	Paper Only
Other-Other	Round_II_CCOE_CtrDirector_PC_Survey_20061020.doc	No	No	Paper Only
Other-Other	Round_II_CCOE_Community_Partner_Survey_20061018.doc	Yes	Yes	Paper Only
Other-Other	Round II CCOE Participant Survey_20061004.doc	Yes	Yes	Paper Only
Other-Other	Round II_CCOE_Site_Visit_Protocol_20061020.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 196	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	196	196
Annual IC Time Burden (Hours)	82	82
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.