State Survey

Survey of State Underage Drinking Prevention Policies and Practices

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0316 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment 5-STOP State Survey Form and Instruction
Attachment 5-STOP Attachment 5-STOP Act State Survey Attachment 5-STOP Act State Survey-6-10-10.pdf Form and Instruction
Attachment 1-STOP Act State Report text-6-10-10.doc Attachment 1-STOP Act IC Document
Attachment 2-STOP Act ICCPUD members 6-10-10.doc Attachment 2-STOP Act ICCPUD Members IC Document
Attachment 3-STOP Act agency comments to FRN-6-14-10.pdf Attachment 3-Comments IC Document
Attachment 4-STOP Act Stakeholder Consultants-6-6-10.doc Attachment 4-Stakeholder Consultants IC Document
Attachment 6-Draft Cover Letter to Governors 6-10-10.doc Attachment 6-Draft Cover Letter to Governors IC Document
Appendix A-STOP Act Categories-1.doc Appendix A-Stop Act Categories-1 IC Document

Information Collection (IC) Details

IC Title:	State 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 5-STOP Act State Survey	Attachment 5-STOP Act State Survey	Attachment 5-STOP Act State Survey-6-10-10.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	903	903
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 1-STOP Act	Attachment 1-STOP Act State Report text-6-10-10.doc	08/03/2010
Attachment 2-STOP Act ICCPUD Members	Attachment 2-STOP Act ICCPUD members 6-10-10.doc	08/03/2010
Attachment 3-Comments	Attachment 3-STOP Act agency comments to FRN-6-14-10.pdf	08/03/2010
Attachment 4-Stakeholder Consultants	Attachment 4-STOP Act Stakeholder Consultants-6-6-10.doc	08/03/2010
Attachment 6-Draft Cover Letter to Governors	Attachment 6-Draft Cover Letter to Governors 6-10-10.doc	08/03/2010
Appendix A-Stop Act Categories-1	Appendix A-STOP Act Categories-1.doc	10/12/2010

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