Information Collection

Web-based Survey - ECCS Coordinators

IC 192518 under ICR 201004-0915-001 · OMB 0915-0332.

Documents and Forms

Document Name Document Type
Form 001 - ECCS Web-based Survey - ECCS Coordinators Form and Instruction
001 - ECCS Attachment A - ECCS Coordinator Survey Attachment A ECCS Coordinator survey final June 4 2010.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Web-based Survey - ECCS Coordinators	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 and Instruction	001 - ECCS	Attachment A - ECCS Coordinator Survey	Attachment A ECCS Coordinator survey final June 4 2010.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	39	39
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.