Survey on Hypertension

Improving the Quality and Delivery of CDC's Heart Disease and Stroke Prevention Programs

Documents and Forms

Document Name Document Type
Att 4b_IC 1_Survey on IOM Hypertension Report.doc Other-Web Survey
Att 4a_IC 1_Overview.doc Overview Document IC Document
Att 4c_IC 1_Advance Notice Email.doc EMail Notice IC Document
Att 4d_IC 1_Follow-Up Email.doc Follow-up Email Notice IC Document

Information Collection (IC) Details

IC Title:	Survey on Hypertension	Agency IC Tracking Number:

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-Web Survey			Att 4b_IC 1_Survey on IOM Hypertension Report.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	51	0	0	0	0	0
Annual IC Time Burden (Hours)	17	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Overview Document	Att 4a_IC 1_Overview.doc	07/12/2010
EMail Notice	Att 4c_IC 1_Advance Notice Email.doc	07/12/2010
Follow-up Email Notice	Att 4d_IC 1_Follow-Up Email.doc	07/12/2010

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