Information Collection

Evaluation of a Prevention Information Prototype in the Context of a HRSA Community Health Center

IC 185676 under ICR 200706-0990-004 · OMB 0990-0281.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0281 can be found here:

Documents and Forms

IC Title:

Agency IC Tracking Number:

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-survey	Pre Survey_0990_0281_#10 (3).doc	No	No	Paper Only
Other-survey	Post Survey_0990_0281_#10 (3).doc	No	No	Paper Only
Other-survey	30 Day Follw up_0990_0281_#10 (3).doc	No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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 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	500	0	0	0	0	0
Annual IC Time Burden (Hours)	117	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo 0990-0281_#10 (2)	OMB Memo 0990-0281_#10 (2).doc	07/10/2008

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