Resources and Services Database of the CDC National Prevention Information Network - Initial Questionnaire Telephone Script: Social and Human Service Assistants

Resources and Services Database of the National Prevention Information Network

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Resources and Services Database of the CDC National Prevention Information Network - Initial Questionnaire Telephone Script: Social and Human Service Assistants Form and Instruction
Appendix F: Annual update Request (E-Mail) Annual update Request (E-Mail).doc 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

Information Collection (IC) Details

IC Title:	Resources and Services Database of the CDC National Prevention Information Network - Initial Questionnaire Telephone Script: Social and Human Service Assistants	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Appendix F: Annual update Request (E-Mail)	Annual update Request (E-Mail).doc	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0255	Att3A_Initial_Res_Org_Quest	Att3A_Initial_Res_Org_Quest.docx	Yes	Yes	Fillable Printable
Form and Instruction	0920-0255	Att3B_initial_quest_tele_scriptClean	Att3B_initial_quest_tele_scriptClean.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 96

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	240	160
Annual IC Time Burden (Hours)	100	60	40
Annual IC Cost Burden (Dollars)	0	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.