Information Collection

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

IC 212594 under ICR 201206-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.