Outcomes Data Collection of the National Prevention Information Network Products and Services Users Survey (Telephone) State and Local Govt

Outcomes Data Collection of the National Prevention Information Network

Documents and Forms

Document Name Document Type
Appendix H NIPN Product & Services User Servey Telephone Script.doc Instruction

Information Collection (IC) Details

IC Title:	Outcomes Data Collection of the National Prevention Information Network Products and Services Users Survey (Telephone) State and Local Govt	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Appendix H NIPN Product & Services User Servey Telephone Script.doc		No	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-50	50
Annual IC Time Burden (Hours)	-13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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