Revised Resource Organization Questionnaire (Fifth Version)

Information Collection of the Resources and Services Database of the National Prevention Information Network: 30 day

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0255 can be found here:

Documents and Forms

Document Name Document Type
Revised Resource Organization Questionnaire (Fifth Version) Form and Instruction
Appendix C Revised Resource Organization Questionnaire ( Revised Resource Organization Questionniare (Fifth Version.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Revised Resource Organization Questionnaire (Fifth Version)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	None	Appendix C Revised Resource Organization Questionnaire (Fifth Version)	Revised Resource Organization Questionniare (Fifth Version.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 40 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,000	867	19,133
Annual IC Time Burden (Hours)	5,667	1,809	3,858
Annual IC Cost Burden (Dollars)	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.