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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.