Information Collection

Cx3 Study - Follow-up Provider Survey

IC 188623 under ICR 201205-0920-008 · OMB 0920-0814.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att D2_Follow-up Provider Survey_0209.doc	Other-WORD
Att D2a_ Cover letter -- follow-up provider surveys_0209.doc Att D2a_ Cover letter -- follow-up provider surveys_0209	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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
Other-WORD					Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 252

Number of Respondents: 23

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-46	46
Annual IC Time Burden (Hours)	-23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att D2a_ Cover letter -- follow-up provider surveys_0209		02/23/2009

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].