Information Collection

Awardee Survey (LMIC)

IC 207806 under ICR 201307-0925-003 · OMB 0925-0681.

Documents and Forms

Document Name Document Type
Att1 Informed Consent.docx Instruction
1 LMIC Att5 LMIC Survey Instrument.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Awardee Survey (LMIC)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Instruction			Att1 Informed Consent.docx		No	No	Paper Only
Form and Instruction	1	LMIC	Att5 LMIC Survey Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 112	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	112	112
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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