Information Collection

State Data User Survey

IC 184632 under ICR 200711-0930-002 · OMB 0930-0290.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0290 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment B - Sur State Data User Survey	Form and Instruction
Attachment B - Sur Attachment B - Survey Attachment B - Web-Based Survey Questionnaire.doc	Form and Instruction
Attachment A - Email Requesting Participation.doc Attachment A - Email for Participation	IC Document
Attachment D - Second Reminder Email.doc Attachment D - 2nd Reminder	IC Document
Attachment C - First Reminder Email.doc Attachment C - 1st Reminder	IC Document
Supporting Statement.doc Justification	IC Document
data user omb memo.doc Memo	IC Document

IC Title:

State Data User Survey

Agency IC Tracking Number:

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 B - Survey	Attachment B - Survey	Attachment B - Web-Based Survey Questionnaire.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 65

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	65	0	0	0	0	0
Annual IC Time Burden (Hours)	16	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A - Email for Participation	Attachment A - Email Requesting Participation.doc	04/24/2008
Attachment D - 2nd Reminder	Attachment D - Second Reminder Email.doc	04/24/2008
Attachment C - 1st Reminder	Attachment C - First Reminder Email.doc	04/24/2008
Justification	Supporting Statement.doc	04/24/2008
Memo	data user omb memo.doc	04/24/2008

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