Information Collection

Resources and Services Database of the CDC National Prevention Information Network - Initial Questionnaire Telephone Script: Health Educators

IC 178804 under ICR 201311-0920-017 · OMB 0920-0255.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0255 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0255 Resources and Services Database of the CDC National Prevention Information Network - Initial Questionnaire Telephone Script: Health Educators	Form and Instruction
0920-0255 Att3A_Initial_Res_Org_Quest Att3A_Initial_Res_Org_Quest.docx	Form and Instruction
0920-0255 Att3B_initial_quest_tele_scriptClean Att3B_initial_quest_tele_scriptClean.docx	Form and Instruction

IC Title:

Resources and Services Database of the CDC National Prevention Information Network - Initial Questionnaire Telephone Script: Health Educators

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 and Instruction	0920-0255	Att3A_Initial_Res_Org_Quest	Att3A_Initial_Res_Org_Quest.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0255	Att3B_initial_quest_tele_scriptClean	Att3B_initial_quest_tele_scriptClean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 12

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	30	20
Annual IC Time Burden (Hours)	11	7	4
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.