Information Collection

Evaluator/Data Manager

IC 196214 under ICR 201102-0930-002 · OMB 0930-0323.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Data Manager Surve Evaluator/Data Manager	Form and Instruction
Data Manager Surve Data Manager Survey A3 Annual Program Survey (Evaluators Data Managers)_FINAL DRAFT_4 26 11 (2).doc	Form and Instruction
B3. All staff emails.doc All staff emails	IC Document

IC Title:

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	Data Manager Survey	Data Manager Survey	A3 Annual Program Survey (Evaluators Data Managers)_FINAL DRAFT_4 26 11 (2).doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

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	28	28
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
All staff emails	B3. All staff emails.doc	01/04/2011

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