Information Collection

CCC Partners Coalition Survey

IC 210389 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⚠️ Notice: This information collection may be referencing outdated material.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 Partners Coalition Survey	Form and Instruction
0920- Att F1_Coalition_Survey Att F1_Coalition_Survey_10_29_13.docx	Form and Instruction
Att F2_Coalition_Survey_Advance E-Mail.docx Att F2_Coalition_Survey_Advance E-Mail	IC Document
Att F3_Coalition_Survey_Recruitment E-Mail.docx Att F3_Coalition_Survey_Recruitment E-Mail	IC Document
Att F4_Coalition_Survey_Reminder E-Mail.docx Att F4_Coalition_Survey_Reminder E-Mail	IC Document
Att F5_Coalition_Survey_Thank You E-Mail.docx Att F5_Coalition_Survey_Thank You E-Mail	IC Document

IC Title:

CCC Partners Coalition Survey

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 F1_Coalition_Survey	Att F1_Coalition_Survey_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: 87

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	87	87
Annual IC Time Burden (Hours)	29	29
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att F2_Coalition_Survey_Advance E-Mail	Att F2_Coalition_Survey_Advance E-Mail.docx	02/11/2014
Att F3_Coalition_Survey_Recruitment E-Mail	Att F3_Coalition_Survey_Recruitment E-Mail.docx	02/11/2014
Att F4_Coalition_Survey_Reminder E-Mail	Att F4_Coalition_Survey_Reminder E-Mail.docx	02/11/2014
Att F5_Coalition_Survey_Thank You E-Mail	Att F5_Coalition_Survey_Thank You E-Mail.docx	02/11/2014

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