Outcomes Data Collection of the National Prevention Information Network Products and Services Users Survey (Telephone) State and Local Govt

Outcomes Data Collection of the National Prevention Information Network

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0768 can be found here:

Documents and Forms

Document Name Document Type
Appendix H NIPN Product & Services User Servey Telephone Script.doc Instruction

Information Collection (IC) Details

IC Title:	Outcomes Data Collection of the National Prevention Information Network Products and Services Users Survey (Telephone) State and Local Govt	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Appendix H NIPN Product & Services User Servey Telephone Script.doc		No	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	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 Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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