Information Collection

CCC Staff Key Informant Selection

IC 210384 under ICR 201402-0920-012 · OMB 0920-1016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- CCC Staff Key Informant Selection	Form and Instruction
0920- Att D3_Key_Informant_Selection_10_29_13 Att D3_Key_Informant_Selection_10_29_13.docx	Form and Instruction

IC Title:

CCC Staff Key Informant Selection

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
Form and Instruction	0920-	Att D3_Key_Informant_Selection_10_29_13	Att D3_Key_Informant_Selection_10_29_13.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

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	2	2
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	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.