Information Collection

Peers recruited

IC 204847 under ICR 201211-0925-007 · OMB 0925-0610.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0610 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Peers recruited	Form and Instruction
2 Peer Online Survey Attachment 2B Peer Online Survey Screen Shots.doc	Form and Instruction
Attachment 2A Peer Survey Hard Copy.doc Attachment 2A Peer Survey Hard Copy	IC Document

IC Title:

Peers recruited

Agency IC Tracking Number:

Is this a Common Form? No

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	2	Peer Online Survey	Attachment 2B Peer Online Survey Screen Shots.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,535

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,535	2,535
Annual IC Time Burden (Hours)	1,690	1,690
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2A Peer Survey Hard Copy	Attachment 2A Peer Survey Hard Copy.doc	11/14/2012

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