Information Collection

Town Hall Meetings Feedback Form

IC 182093 under ICR 200709-0930-004 · OMB 0930-0288.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0288 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 1 - For Town Hall Meetings Feedback Form	Form and Instruction
Attachment 1 - For Attachment 1 - Form Attachment 1 THM OMB 2007.doc	Form and Instruction
Attachment 2 THM OMB 2007.doc Attachment 2 - Comments	IC Document
Attachment 3 THM OMB 2997.doc Attachment 3 - CBO Verification Letter	IC Document
Attachment 4 THM OMB 2007.doc Attachment 4 - Initial Mailing Letter	IC Document
Attachment 5 THM OMB 2007.doc Attachment 5 - Follow-up Mailing Letter	IC Document

IC Title:

Town Hall Meetings Feedback Form

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	Attachment 1 - Form	Attachment 1 - Form	Attachment 1 THM OMB 2007.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	1,200	1,200
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2 - Comments	Attachment 2 THM OMB 2007.doc	09/06/2007
Attachment 3 - CBO Verification Letter	Attachment 3 THM OMB 2997.doc	09/06/2007
Attachment 4 - Initial Mailing Letter	Attachment 4 THM OMB 2007.doc	09/06/2007
Attachment 5 - Follow-up Mailing Letter	Attachment 5 THM OMB 2007.doc	09/06/2007

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