Organizers Survey

Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.