Participants 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⚠️ Notice: This information collection may be referencing outdated material.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 2 - Par Participants Survey Form and Instruction
Attachment 2 - Par Attachment 2 - Participants Survey Attachment 2-Participants Survey_060110.doc Form and Instruction
Attachment 2- Part Attachment 2-Participants Survey Attachment 2-Participants Survey_092710.doc Form and Instruction
Attachment 2 Attachment 2-Participant Form 102810-Final Attachment 2-Participant Form_102810-FINAL.doc Form and Instruction
Attachment 6-Registration-Confirmation of Participation Email_060110.doc Attachment 6 - Registration-Confirmation IC Document
Attachment 6-Participants Survey Card.png Attachment 6-Participants Survey Card IC Document
Attachment 8-Registration-Confirmation of Participation Email_092710.doc Attachment 8-Registration Confirmation of Participation Email 92710 IC Document

Information Collection (IC) Details

IC Title:	Participants Survey	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 2 - Participants Survey	Attachment 2 - Participants Survey	Attachment 2-Participants Survey_060110.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment 2- Participants Survey	Attachment 2-Participants Survey	Attachment 2-Participants Survey_092710.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment 2	Attachment 2-Participant Form 102810-Final	Attachment 2-Participant Form_102810-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: 12,000	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	12,000	12,000
Annual IC Time Burden (Hours)	996	996
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 6 - Registration-Confirmation	Attachment 6-Registration-Confirmation of Participation Email_060110.doc	08/02/2010
Attachment 6-Participants Survey Card	Attachment 6-Participants Survey Card.png	09/29/2010
Attachment 8-Registration Confirmation of Participation Email 92710	Attachment 8-Registration-Confirmation of Participation Email_092710.doc	09/29/2010

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