Information Collection

Outcomes Data Collection of the National Prevention Information Network Product and Services Users Survey- State and Local Government

IC 182789 under ICR 201103-0920-005 · OMB 0920-0768.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E NPIN Product and Services User Survey.doc	Instruction
Appendix F Introductory Email P&S User Survey.doc Introductory Email for NPIN Products and Services User Survey	IC Document
Appendix G Reminder Email for P&S User Survey.doc Email Reminder for NPIN Products and Services User Survey	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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
Instruction			Appendix E NPIN Product and Services User Survey.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 222

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-444	444
Annual IC Time Burden (Hours)	-111	111
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Introductory Email for NPIN Products and Services User Survey	Appendix F Introductory Email P&S User Survey.doc	10/12/2007
Email Reminder for NPIN Products and Services User Survey	Appendix G Reminder Email for P&S User Survey.doc	10/12/2007

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