Information Collection

Institutional Awareness and Commitment Survey (Partner Organizations)

IC 210318 under ICR 201402-0920-005 · OMB 0920-1010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1010 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment D - Survey.docx	Other-WORD
Attachment C - Survey Screenshots.pdf Attachment C - Survey Screenshots	IC Document
Attachment E- Email Invitation.docx Attachment E- Email Invitation	IC Document
Attachment F - Email Invitation Follow-up.docx Attachment F - Email Invitation Follow-up	IC Document

IC Title:

Institutional Awareness and Commitment Survey (Partner Organizations)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-WORD			Attachment D - Survey.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment C - Survey Screenshots	Attachment C - Survey Screenshots.pdf	02/06/2014
Attachment E- Email Invitation	Attachment E- Email Invitation.docx	02/06/2014
Attachment F - Email Invitation Follow-up	Attachment F - Email Invitation Follow-up.docx	02/06/2014

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