Information Collection

Survey of Health Professional Perceptions and Use of Center TRT Services

IC 199300 under ICR 201102-0920-005 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.