Information Collection

Feedback Publication: OTP: 2013 State Profile

IC 207353 under ICR 201103-0930-003 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OTP Report Survey Feedback Publication: OTP: 2013 State Profile	Form and Instruction
OTP Report Survey OTP Report Survey OTPReportSurvey.pdf	Form and Instruction
OMBclearance-OTPsurvey130613.docx Justification	IC Document
RecruitmentEmail130613.docx Recruitment Email	IC Document
Trans.Let-10-2013.doc Transmittal Letter	IC Document

IC Title:

Feedback Publication: OTP: 2013 State Profile

Agency IC Tracking Number:

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	OTP Report Survey	OTP Report Survey	OTPReportSurvey.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 99

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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	99	0	0	0	0	0
Annual IC Time Burden (Hours)	17	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	OMBclearance-OTPsurvey130613.docx	06/13/2013
Recruitment Email	RecruitmentEmail130613.docx	06/13/2013
Transmittal Letter	Trans.Let-10-2013.doc	06/13/2013

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