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Town Hall Meetings Feedback Form
Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative
OMB: 0930-0288
IC ID: 182093
OMB.report
HHS/SAMHSA
OMB 0930-0288
ICR 200709-0930-004
IC 182093
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0288 can be found here:
2023-10-31 - Revision of a currently approved collection
2022-03-28 - Reinstatement with change of a previously approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
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
Federal Enterprise Architecture Business Reference Module
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 %
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
1,200
0
1,200
0
0
0
Annual IC Time Burden (Hours)
200
0
200
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.