Regions IV VI Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) Participant Satisfaction Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Regions IV VI Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) Participant Satisfaction Survey Form and Instruction
1 Regions IV and VI Infant Mortality CoIIN Participant Sat CoIIN Participant Satisfaction Survey PARTS I II.docx Form and Instruction
Supporting Statement.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Regions IV VI Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) Participant Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Regions IV and VI Infant Mortality CoIIN Participant Satisfaction Survey	CoIIN Participant Satisfaction Survey PARTS I II.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Supporting Statement.docx	08/06/2014

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