Evaluation of Potential Sources for the Sentinel Initiative

Documents and Forms

Document Name Document Type
Sentinel Draft Data Collection Survey 02-23-10 - v1.xls Other-evaluation
Sentinel Survey Instructions 8-25-09.doc Sentinel Survey Instructions 8-25-09 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of Potential Sources for the Sentinel Initiative	Agency IC Tracking Number:

Is this a Common Form?		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
Other-evaluation			Sentinel Draft Data Collection Survey 02-23-10 - v1.xls		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	6,125	6,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sentinel Survey Instructions 8-25-09	Sentinel Survey Instructions 8-25-09.doc	09/01/2009

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