Information Collection

National Recovery Month

IC 222611 under ICR 201306-0930-003 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Screening Question National Recovery Month	Form and Instruction
Screening Question Screening Questionnaire 2016_7_21_ATTACHMENT A_2017 RM Recruiting and Screening Questionnaire.docx	Form and Instruction
Moderator's Guide Moderator's Guide 2016_7_21_ATTACHMENT B_RM 2017 English Moderator's Guide.docx	Form and Instruction
Consent Form Consent Form 2016_7_21_ATTACHMENT C_2017 RM Consent Form ENG.docx	Form and Instruction
TransLet-7doc.doc Transmittal Letter	IC Document
2016_7_25_CSAT RM Focus Groups - 2017 OMB Supporting Statement.doc Justification	IC Document

IC Title:

National Recovery Month

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Screening Questionnaire	Screening Questionnaire	2016_7_21_ATTACHMENT A_2017 RM Recruiting and Screening Questionnaire.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Moderator's Guide	Moderator's Guide	2016_7_21_ATTACHMENT B_RM 2017 English Moderator's Guide.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Consent Form	Consent Form	2016_7_21_ATTACHMENT C_2017 RM Consent Form ENG.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	88	88
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Transmittal Letter	TransLet-7doc.doc	07/25/2016
Justification	2016_7_25_CSAT RM Focus Groups - 2017 OMB Supporting Statement.doc	07/25/2016

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