Information Collection

Director

IC 196212 under ICR 201102-0930-002 · OMB 0930-0323.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Director Survey Director	Form and Instruction
Director Survey Director Survey A1 Annual Program Survey (PIs PDs)_FINAL DRAFT_4 26 11.doc	Form and Instruction
B1. PI.PD emails.doc PI.PD emails	IC Document

IC Title:

Director

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 and Instruction	Director Survey	Director Survey	A1 Annual Program Survey (PIs PDs)_FINAL DRAFT_4 26 11.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 21

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	21	21
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PI.PD emails	B1. PI.PD emails.doc	01/04/2011

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