Information Collection

Outcomes Data Collection of the National Prevention Information Network NPIN Products and Services User Survey Private Sector Organizations

IC 182788 under ICR 201103-0920-005 · OMB 0920-0768.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Outcomes Data Collection of the National Prevention Information Network NPIN Products and Services User Survey Private Sector Organizations	Form
NPIN Products and Services User Survey 0920_0768_2010_NPIN_att3-D_ProdServiceSurvey.doc	Form
0920_0768_2010_NPIN_att3-C_IntroForProdServiceSurvey.doc Attachment 3c - Intro for Products and Services Survey	IC Document
0920_0768_2010_NPIN_att3-E_ReminderForProdServiceSurvey.doc Attachment 3e - Reminder for Products and Services Survey	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241

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	none	NPIN Products and Services User Survey	0920_0768_2010_NPIN_att3-D_ProdServiceSurvey.doc		No	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,000	0	-3,310	4,310
Annual IC Time Burden (Hours)	217	-861	0	1,078
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 3c - Intro for Products and Services Survey	0920_0768_2010_NPIN_att3-C_IntroForProdServiceSurvey.doc	03/14/2011
Attachment 3e - Reminder for Products and Services Survey	0920_0768_2010_NPIN_att3-E_ReminderForProdServiceSurvey.doc	03/14/2011

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