Information Collection

Reader Survey: NCCAM Newsletter

IC 189723 under ICR 200809-0925-003 · OMB 0925-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0530 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Reader Survey: NCCAM Newsletter	Form
1 survey NCAAM 6 16 09.docx	Form
cover memo 6 11 2009.doc cover memo 6 11 2009	IC Document
generic_clearance_form 6 11 2009.doc generic_clearance_form 6 11 2009	IC Document

IC Title:

Reader Survey: NCCAM Newsletter

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	1	survey	NCAAM 6 16 09.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

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	400	0	0	0	0	0
Annual IC Time Burden (Hours)	20	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
cover memo 6 11 2009	cover memo 6 11 2009.doc	06/18/2009
generic_clearance_form 6 11 2009	generic_clearance_form 6 11 2009.doc	06/18/2009

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