Information Collection

Web-based Surveys

IC 181872 under ICR 200709-0930-001 · OMB 0930-0289.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Surveys Web-based Surveys	Form and Instruction
Surveys Surveys Surveys.zip	Form and Instruction
Letters.zip Letters	IC Document

IC Title:

Web-based Surveys

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	Surveys	Surveys	Surveys.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,063

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,063	2,063
Annual IC Time Burden (Hours)	2,063	2,063
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Letters	Letters.zip	08/23/2007

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