Information Collection

Program Partners

IC 200084 under ICR 201111-0920-002 · OMB 0920-0921.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Program Partners	Form and Instruction
Web Survey Attachment D1. Program Partners Web Survey_rev 1 18 2012.docx	Form and Instruction
Attachment D2. Program Partners Invitation Email.docx Att D2 - Invitation email	IC Document
Attachment D3. Program Partners Follow Up Email.docx Att D3 - Follow-up Email	IC Document
Attachment D4. Program Partners Postcard.docx Att D4 - Postcard reminder	IC Document
Attachment D5. Program Partners Thank You Email.docx Att D5 - Thank you Email	IC Document

IC Title:

Program Partners

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	none	Web Survey	Attachment D1. Program Partners Web Survey_rev 1 18 2012.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 132

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	132	132
Annual IC Time Burden (Hours)	66	66
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att D2 - Invitation email	Attachment D2. Program Partners Invitation Email.docx	10/31/2011
Att D3 - Follow-up Email	Attachment D3. Program Partners Follow Up Email.docx	10/31/2011
Att D4 - Postcard reminder	Attachment D4. Program Partners Postcard.docx	10/31/2011
Att D5 - Thank you Email	Attachment D5. Program Partners Thank You Email.docx	10/31/2011

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