Information Collection

CPHP Customer/Partner Survey Instrument

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CPHP Customer/Partner Survey Instrument	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	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 %

	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

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.