Survey of Health Professional Perceptions and Use of Center TRT Services

Surveys of State, Tribal, Local and Territorial (STLT) Governmental Health Agencies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Survey of Health Professional Perceptions and Use of Center TRT Services Form
Survey of Obesity Programs Attachment C Center TRT Survey Instrument Word (2).docx Form
Survey of Obesity Program - web version Attachment D Web Screen Shots of Survey Instrument.docx Form
Revised Survey of Obesity Programs - Word version REVISED Attachment C Center TRT Survey Instrument Word.docx Form
Revised Survey of Obesity Programs - Web Version REVISED Attachment D Web Screen Shots of Survey Instrument.docx Form
Attachment E - Initial Notification Email_Center TRT (2).docx Att E - Survey notification email IC Document
Obesity Program- Attachment F - Follow-up Email_Center TRT.docx Att F - Follow-up email IC Document
Obesity Program- Attachment G - Final Reminder Email_Center TRT.docx Att G - Final reminder email IC Document
Obesity Program- Attachment B Example Center TRT Products.docx Att B - Examples of center TRT products IC Document
Center TRT Supporting Statement A (2).docx Supporting Statement A IC Document
Obesity Program- Supporting Statement Part B.docx Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	Survey of Health Professional Perceptions and Use of Center TRT Services	Agency IC Tracking Number:

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	none	Survey of Obesity Programs	Attachment C Center TRT Survey Instrument Word (2).docx	Yes	Yes	Fillable Fileable
Form	none	Survey of Obesity Program - web version	Attachment D Web Screen Shots of Survey Instrument.docx	Yes	Yes	Fillable Fileable
Form	none	Revised Survey of Obesity Programs - Word version	REVISED Attachment C Center TRT Survey Instrument Word.docx	No		Paper Only
Form	none	Revised Survey of Obesity Programs - Web Version	REVISED Attachment D Web Screen Shots of Survey Instrument.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 177	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	177	177
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att E - Survey notification email	Attachment E - Initial Notification Email_Center TRT (2).docx	09/19/2011
Att F - Follow-up email	Obesity Program- Attachment F - Follow-up Email_Center TRT.docx	09/19/2011
Att G - Final reminder email	Obesity Program- Attachment G - Final Reminder Email_Center TRT.docx	09/19/2011
Att B - Examples of center TRT products	Obesity Program- Attachment B Example Center TRT Products.docx	09/19/2011
Supporting Statement A	Center TRT Supporting Statement A (2).docx	09/19/2011
Supporting Statement B	Obesity Program- Supporting Statement Part B.docx	09/19/2011

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