Information Collection

414 ePSS, 415 FCIC 11Feb2011, 416 FCIC Pueblo 11Feb2011, 417 Howto.gov 3.7.2011 , 418 NLM Clinical Trials, 419 CMS Palmetto GBA J11 MAC, 420 Recreation.gov 2-4-2011 to 3-25-11, 421 DHHS-PSC , 422 DOT

IC 197067 under ICR 201101-1090-002 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Document Name Document Type
Form 414 ePSS Questionn 414 ePSS, 415 FCIC 11Feb2011, 416 FCIC Pueblo 11Feb2011, 417 Howto.gov 3.7.2011 , 418 NLM Clinical Trials, 419 CMS Palmetto GBA J11 MAC, 420 Recreation.gov 2-4-2011 to 3-25-11, 421 DHHS-PSC , 422 DOT Form
414 ePSS Questionn 414 ePSS Questionnaire Wave 1 Revised 2011 414 ePSS Questionnaire Wave 1 Revised.xlsx Form
415 FCIC Consumer 415 FCIC Consumer Action CQ revisions_11Feb2011 2011 415 FCIC Consumer Action CQ revisions_11Feb2011.xlsx Form
416 FCIC Pueblo Su 416 FCIC Pueblo Survey revisions_11Feb2011 2011 416 FCIC Pueblo Survey revisions_11Feb2011.xlsx Form
417 Howto.gov Surv 417 Howto.gov Survey 3.7.2011 - current 2011 417 Howto.gov Survey 3.7.2011 - current.xlsx Form
418 NLM Clinical T 418 NLM Clinical Trials Questionnaire _2-14-11 2011 418 NLM Clinical Trials Questionnaire _2-14-11.xls Form
419 CMS Palmetto G 419 CMS Palmetto GBA J11 MAC Questionnaire 3-10-11 2011 419 CMS Palmetto GBA J11 MAC Questionnaire 3-10-11.xlsx Form
420 CQs for OMB 2- 420 CQs for OMB 2-4-2011 to 3-25-11 2011 420 CQs for OMB 2-4-2011 to 3-25-11.xlsx Form
421 DHHS-PSC Offli 421 DHHS-PSC Offline Services Questionnaire 02-25-11 2011 421 DHHS-PSC Offline Services Questionnaire 02-25-11.xlsx Form
422 DOT FHWA Quest 422 DOT FHWA Questionnaire 02-17-2011 2011 422 DOT FHWA Questionnaire 02-17-2011.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	414 ePSS, 415 FCIC 11Feb2011, 416 FCIC Pueblo 11Feb2011, 417 Howto.gov 3.7.2011 , 418 NLM Clinical Trials, 419 CMS Palmetto GBA J11 MAC, 420 Recreation.gov 2-4-2011 to 3-25-11, 421 DHHS-PSC , 422 DOT	Agency IC Tracking Number:	414-422

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	414 ePSS Questionnaire Wave 1 Revised	414 ePSS Questionnaire Wave 1 Revised	2011 414 ePSS Questionnaire Wave 1 Revised.xlsx	Yes	Yes	Fillable Fileable
Form	415 FCIC Consumer Action CQ revisions_11Feb2011	415 FCIC Consumer Action CQ revisions_11Feb2011	2011 415 FCIC Consumer Action CQ revisions_11Feb2011.xlsx	Yes	Yes	Fillable Fileable
Form	416 FCIC Pueblo Survey revisions_11Feb2011	416 FCIC Pueblo Survey revisions_11Feb2011	2011 416 FCIC Pueblo Survey revisions_11Feb2011.xlsx	Yes	Yes	Fillable Fileable
Form	417 Howto.gov Survey 3.7.2011 - current	417 Howto.gov Survey 3.7.2011 - current	2011 417 Howto.gov Survey 3.7.2011 - current.xlsx	Yes	Yes	Fillable Fileable
Form	418 NLM Clinical Trials Questionnaire _2-14-11	418 NLM Clinical Trials Questionnaire _2-14-11	2011 418 NLM Clinical Trials Questionnaire _2-14-11.xls	Yes	Yes	Fillable Fileable
Form	419 CMS Palmetto GBA J11 MAC Questionnaire 3-10-11	419 CMS Palmetto GBA J11 MAC Questionnaire 3-10-11	2011 419 CMS Palmetto GBA J11 MAC Questionnaire 3-10-11.xlsx	Yes	Yes	Fillable Fileable
Form	420 CQs for OMB 2-4-2011 to 3-25-11	420 CQs for OMB 2-4-2011 to 3-25-11	2011 420 CQs for OMB 2-4-2011 to 3-25-11.xlsx	Yes	Yes	Fillable Fileable
Form	421 DHHS-PSC Offline Services Q's 02-25-11	421 DHHS-PSC Offline Services Questionnaire 02-25-11	2011 421 DHHS-PSC Offline Services Questionnaire 02-25-11.xlsx	Yes	Yes	Fillable Fileable
Form	422 DOT FHWA Questionnaire 02-17-2011	422 DOT FHWA Questionnaire 02-17-2011	2011 422 DOT FHWA Questionnaire 02-17-2011.xlsx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45,000	45,000
Annual IC Time Burden (Hours)	1,875	1,875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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