Information Collection

Questionnaire - Police Officers

IC 206655 under ICR 201304-0920-014 · OMB 0920-0988.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment C - CDC Questionnaire.docx	Other-WORD
Attachment G - CDC screenshots 2013.pdf Screenshots	IC Document
Attachment F - Email invitation letter.doc Email Invitation	IC Document

IC Title:

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
Other-WORD			Attachment C - CDC Questionnaire.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	600	600
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screenshots	Attachment G - CDC screenshots 2013.pdf	04/23/2013
Email Invitation	Attachment F - Email invitation letter.doc	04/23/2013

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