Information Collection

Organizers Survey

IC 182093 under ICR 201008-0930-003 · OMB 0930-0288.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0288 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 1 - Org Organizers Survey	Form and Instruction
Attachment 1 - Org Attachment 1 - Organizers Survey Attachment 1-Organizers Survey_060110.doc	Form and Instruction
Attachment 3 - Fee Attachment 3 - Feedback Form Attachment 3-Town Hall Meeting Feedback Form_060110.doc	Form and Instruction
Attachment 1 Attachment 1-Organizers Survey 092710 Attachment 1-Organizers Survey_092710.doc	Form and Instruction
Attachment 1 Attachment 1- Organizer Survey 110310-Final Attachment 1-Organizer Survey_110310-FINAL.doc	Form and Instruction
Attachment 4-Initial Email to Organizers-Survey_060110.doc Attachment 4 - Initial E-mail	IC Document
Attachment 5-Reminder Email to Organizers-Survey_060110.doc Attachment 5 - Reminder E-mail	IC Document
Attachment 4-Initial Email to Organizers-Survey_092710.doc Attachment 4-Initial Email to Organizers Survey 092710	IC Document
Attachment 5-Reminder Email to Organizers-Survey_092710.doc Attachment 5-Reminder Email to Organizers-Survey -092710	IC Document
Attachment 7-ICF Macro IRB Findings Form.pdf Attachment 7-ICF Macro IRB Findings Form	IC Document

IC Title:

Organizers Survey

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 1 - Organizers Survey	Attachment 1 - Organizers Survey	Attachment 1-Organizers Survey_060110.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment 3 - Feedback Form	Attachment 3 - Feedback Form	Attachment 3-Town Hall Meeting Feedback Form_060110.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment 1	Attachment 1-Organizers Survey 092710	Attachment 1-Organizers Survey_092710.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment 1	Attachment 1- Organizer Survey 110310-Final	Attachment 1-Organizer Survey_110310-FINAL.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,400

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	3,400	2,200	1,200
Annual IC Time Burden (Hours)	1,700	1,500	200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 4 - Initial E-mail	Attachment 4-Initial Email to Organizers-Survey_060110.doc	08/02/2010
Attachment 5 - Reminder E-mail	Attachment 5-Reminder Email to Organizers-Survey_060110.doc	08/02/2010
Attachment 4-Initial Email to Organizers Survey 092710	Attachment 4-Initial Email to Organizers-Survey_092710.doc	09/29/2010
Attachment 5-Reminder Email to Organizers-Survey -092710	Attachment 5-Reminder Email to Organizers-Survey_092710.doc	09/29/2010
Attachment 7-ICF Macro IRB Findings Form	Attachment 7-ICF Macro IRB Findings Form.pdf	09/29/2010

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