Information Collection

CCOE Community Partner Survey

IC 46715 under ICR 200701-0990-004 · OMB 0990-0271.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.