Information Collection

Evaluation of Potential Sources for the Sentinel Initiative

IC 190617 under ICR 200909-0910-004 · OMB 0910-0657.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form?

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.