Information Collection

Online Survey for Point of Contact of Host Institutions

IC 204299 under ICR 201308-0925-004 · OMB 0925-0665.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 8 Online Survey for Point of Contact of Host Institutions	Form
Attachment 8 Screenshots of the Online POC EIA Host Survey Screenshots Online Survey Point of Contact Host Institution.pdf	Form
Attachment B.2.2 - Protocols Online Survey POC Host Institution.doc On-line Survey Protocols	IC Document
Attachment 8 Proposed Final Online Survey Point of Contact Host Institution.doc Attachment 8: Word vesion of the POC EIA Host Survey	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Attachment 8	Screenshots of the Online POC EIA Host Survey	Screenshots Online Survey Point of Contact Host Institution.pdf		Yes	Yes	Fillable Printable

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40	16	24
Annual IC Time Burden (Hours)	13	-11	24
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
On-line Survey Protocols	Attachment B.2.2 - Protocols Online Survey POC Host Institution.doc	09/26/2012
Attachment 8: Word vesion of the POC EIA Host Survey	Attachment 8 Proposed Final Online Survey Point of Contact Host Institution.doc	08/16/2013

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