Information Collection

General Survey for Applicants

IC 184085 under ICR 200803-0925-003 · OMB 0925-0591.

Documents and Forms

Document Name Document Type
Form 1 General Survey for Applicants Form and Instruction
1 Survey GRIP SS Attachment 1 - Survey Instruments 11.27.2007.doc Form and Instruction
GRIP SS Attachment 3 - Intro and follow-up emails 03 03 08.doc GRIP SS Attachment 3 - Intro and follow-up emails 03 03 08 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	General Survey for Applicants	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	1	Survey	GRIP SS Attachment 1 - Survey Instruments 11.27.2007.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 101	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	101	101
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GRIP SS Attachment 3 - Intro and follow-up emails 03 03 08	GRIP SS Attachment 3 - Intro and follow-up emails 03 03 08.doc	03/06/2008

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