Participant Self-Identification Information

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (HITRC)

OMB: 0955-0003

IC ID: 205262

Information Collection (IC) Details

View Information Collection (IC)

Participant Self-Identification Information
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 User Self-ID Registration Questions Cornell Planning Room.docx No No Fillable Printable

Health Illness Prevention

 

175 0
   
Individuals or Households
 
   0 %

  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 175 0 0 0 0 0
Annual IC Time Burden (Hours) 175 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cornell Planning Room Supporting Statement A Cornell Planning Room Supporting Statement A.docx 01/03/2013
Cornell Planning Room Supporting Statement B Cornell Planning Room Supporting Statement B.docx 01/03/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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