Information Collection

Community residents

IC 194099 under ICR 201008-0990-001 · OMB 0990-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0360 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Community residents	Form
1 Community Events Survey Respondent-Community residents workshop evaluation 9_16_10.doc	Form
0990-GirlsatRisk Appendix E- Unique Code Developer.doc 0990-GirlsatRisk Appendix E- Unique Code Developer	IC Document

IC Title:

Community residents

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Community Events Survey	Respondent-Community residents workshop evaluation 9_16_10.doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-GirlsatRisk Appendix E- Unique Code Developer	0990-GirlsatRisk Appendix E- Unique Code Developer.doc	07/23/2010

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