Information Collection

Nomination

IC 200877 under ICR 201201-0920-009 · OMB 0920-0927.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Nomination	Form and Instruction
1 Nutrition and Physical Activity Initiatives to Prevent O Att 4A_PROGRAM NOMINATION FORM - hardcopy.doc	Form and Instruction
2 Nutrition and Physical Activity Initiatives to Prevent O Att 4B_Program Nomination form web-based screenshots.pdf	Form and Instruction
Att 4C_Nomination Solicitation Email.doc Att 4C_Nomination Solicitation Email	IC Document

IC Title:

Nomination

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	1	Nutrition and Physical Activity Initiatives to Prevent Obesity	Att 4A_PROGRAM NOMINATION FORM - hardcopy.doc		Yes	Yes	Paper Only
Form and Instruction	2	Nutrition and Physical Activity Initiatives to Prevent Obesity	Att 4B_Program Nomination form web-based screenshots.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	51	51
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 4C_Nomination Solicitation Email	Att 4C_Nomination Solicitation Email.doc	01/19/2012

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