Information Collection

D-atm

IC 181679 under ICR 200708-0930-004 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form D-ATM Survey D-ATM	Form and Instruction
D-ATM Survey D-ATM Survey ATT 1A_OTP Survey_Text Version.doc	Form and Instruction
ATT 3_OTP Survey Phone Script_Draft.doc Attachment 3-OTP Survey Phone Script	IC Document
ATT 1B_Screen Shots of Survey.doc Attachment 1B-Screen Shots of Survey	IC Document
ATT 2_Dr Clark Letter to OTPs.doc Attachment 2-Dr. Clark Letter to OTPs	IC Document
ATT 4_Pilot Selection Recommendation.doc Attachment 4-Pilot Selection Recommendation	IC Document

IC Title:

D-ATM

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	D-ATM Survey	D-ATM Survey	ATT 1A_OTP Survey_Text Version.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 160

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 3-OTP Survey Phone Script	ATT 3_OTP Survey Phone Script_Draft.doc	08/02/2007
Attachment 1B-Screen Shots of Survey	ATT 1B_Screen Shots of Survey.doc	08/02/2007
Attachment 2-Dr. Clark Letter to OTPs	ATT 2_Dr Clark Letter to OTPs.doc	08/02/2007
Attachment 4-Pilot Selection Recommendation	ATT 4_Pilot Selection Recommendation.doc	08/02/2007

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