Information Collection

General Survey for Applicants

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.