Information Collection

CPHP Customer/Partner Survey Instrument

IC 190130 under ICR 200907-0920-004 · OMB 0920-0826.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CPHP Customer/Partner Survey Instrument	Form
Customer/Partner Survey Instrument Attachment D_Customer-Partner Survey Instrument.CDC FINAL.doc	Form
Attachment F_Telephone initial contact.doc Attachment F - Phone Call Establishing Initial Contact	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	none	Customer/Partner Survey Instrument	Attachment D_Customer-Partner Survey Instrument.CDC FINAL.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 171

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	171	171
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F - Phone Call Establishing Initial Contact	Attachment F_Telephone initial contact.doc	07/13/2009

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