Organizers Survey

Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0288 can be found here:

Documents and Forms

Document Name Document Type
Form Organizer Survey Organizers Survey Form and Instruction
Organizer Survey Organizer Survey Attachment 1-Organizer Survey_052313.doc Form and Instruction
Attachment 5-Initial E-mail to Organizers-Organizer Survey_052313.doc Initial E-mail to Organizers IC Document
Attachment 6-Reminder E-mail to Organizers-Organizer Survey_052313.doc Reminder E-mail to Organizers IC Document
Attachment 4-ICF IRB Review Findings Form_12.19.13.pdf IRB Review Form IC Document

Information Collection (IC) Details

IC Title:	Organizers Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	Organizer Survey	Organizer Survey	Attachment 1-Organizer Survey_052313.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,220	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,220	-1,180	3,400
Annual IC Time Burden (Hours)	739	-961	1,700
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Initial E-mail to Organizers	Attachment 5-Initial E-mail to Organizers-Organizer Survey_052313.doc	08/20/2013
Reminder E-mail to Organizers	Attachment 6-Reminder E-mail to Organizers-Organizer Survey_052313.doc	08/20/2013
IRB Review Form	Attachment 4-ICF IRB Review Findings Form_12.19.13.pdf	01/02/2014

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