OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey

IC 209574 under ICR 201312-0920-003 · OMB 0920-1007.

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Survey - screenshots Appendix C2 Screenshots of Survey Questionnaire_Revised _120313..pdf Yes Yes Fillable Fileable
Form none Survey - Word Appendix C1 CBS National Survey_Questionaire_Revised 120313.docx No No Printable Only

Health Immunization Management

 

3,139 0
   
State, Local, and Tribal Governments
 
   98 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,139 0 3,139 0 0 0
Annual IC Time Burden (Hours) 1,570 0 1,570 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
D1 - Invitation Letter Appendix D1 Study_Invitation_Letter_10 28 2013.docx 12/04/2013
D2 - Study Fact Sheet Appendix D2 Study Fact Sheet_12032013.docx 12/04/2013
D3 - Instructions for Accessing Survey Appendix D3 Instructions for Accessing the Web Survey_12032013.docx 12/04/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.