Information Collection

National Multicultural Outreach Initiative (NMOI) Pilot Study

IC 202020 under ICR 201112-0925-001 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 National Multicultural Outreach Initiative (NMOI) Pilot Study	Form and Instruction
1 Health Planner Survey Health Planner Survey Monkey Screen shots 04 17 12.docx	Form and Instruction
Fast-track template NMOI pilot study 04 17 12.doc Fast-track template NMOI pilot study 04 17 12	IC Document
Health Planner End User Survey_2012 04 17.docx Health Planner End User Survey_2012 04 17	IC Document
Health Planner End User Survey_2012 SPANISH 04-17-12.docx Health Planner End User Survey_2012 SPANISH 04-17-12	IC Document
Health Planner Spanish Survey Monkey Screen Shots 04 17 12.docx Health Planner Spanish Survey Monkey Screen Shots 04 17 12	IC Document
NMOI_Survey Packet_Cover Letter_2012 04 18.docx NMOI_Survey Packet_Cover Letter_2012 04 18	IC Document
NMOI_Survey Packet_Cover Letter_2012 SPANISH 04-18-12.docx NMOI_Survey Packet_Cover Letter_2012 SPANISH 04-18-12	IC Document

IC Title:

National Multicultural Outreach Initiative (NMOI) Pilot Study

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	1	Health Planner Survey	Health Planner Survey Monkey Screen shots 04 17 12.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

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	700	0	0	0	0	0
Annual IC Time Burden (Hours)	233	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
Fast-track template NMOI pilot study 04 17 12	Fast-track template NMOI pilot study 04 17 12.doc	04/18/2012
Health Planner End User Survey_2012 04 17	Health Planner End User Survey_2012 04 17.docx	04/18/2012
Health Planner End User Survey_2012 SPANISH 04-17-12	Health Planner End User Survey_2012 SPANISH 04-17-12.docx	04/18/2012
Health Planner Spanish Survey Monkey Screen Shots 04 17 12	Health Planner Spanish Survey Monkey Screen Shots 04 17 12.docx	04/18/2012
NMOI_Survey Packet_Cover Letter_2012 04 18	NMOI_Survey Packet_Cover Letter_2012 04 18.docx	04/18/2012
NMOI_Survey Packet_Cover Letter_2012 SPANISH 04-18-12	NMOI_Survey Packet_Cover Letter_2012 SPANISH 04-18-12.docx	04/18/2012

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