Information Collection

The Evaluation of the Smoke Alarm Installation and Fire Safety Education (SAIFE) Program

IC 43619 under ICR 200909-0920-002 · OMB 0920-0730.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 The Evaluation of the Smoke Alarm Installation and Fire Safety Education (SAIFE) Program	Form
1 Get Alarmed North Carolina! Screener Part 2 Worksheet.Screener_Household_.8-24-09.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Get Alarmed North Carolina! Screener	Part 2 Worksheet.Screener_Household_.8-24-09.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 425

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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	425	-756	1,181
Annual IC Time Burden (Hours)	35	-216	251
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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