State Survey

Survey of State Underage Drinking Prevention Policies and Practices

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0316 can be found here:

Documents and Forms

Document Name Document Type
Form State Survey State Survey Form and Instruction
State Survey State Survey Attachment 3- 2013 STOP Act Survey with OMB edits 02 08 13.docx Form and Instruction
Attachment 2 - ICCPUD Principals List.docx ICCPUD Principals List IC Document
Attachment 1 - STOP Act as enacted Dec. 20, 2006.rtf STOP Act IC Document
Attachment 4 - Sample data tables for AL and AK.doc Sample data tables for AL and AK IC Document
Attachment 5 - Sample Letter to Governors.docx Sample Letter to Governors IC Document

Information Collection (IC) Details

IC Title:	State Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	State Survey	State Survey	Attachment 3- 2013 STOP Act Survey with OMB edits 02 08 13.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	903	903
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ICCPUD Principals List	Attachment 2 - ICCPUD Principals List.docx	08/24/2012
STOP Act	Attachment 1 - STOP Act as enacted Dec. 20, 2006.rtf	08/24/2012
Sample data tables for AL and AK	Attachment 4 - Sample data tables for AL and AK.doc	08/24/2012
Sample Letter to Governors	Attachment 5 - Sample Letter to Governors.docx	08/24/2012

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