Information Collection

Ethics Participant Feedback Form

IC 195853 under ICR 201403-0930-002 · OMB 0930-0195.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0195 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Forms in IC-1 Ethics Participant Feedback Form	Form and Instruction
Forms in IC-1 Forms in IC-1 No instruments[2].doc	Form and Instruction

IC Title:

Ethics Participant Feedback Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Forms in IC-1	Forms in IC-1	No instruments[2].doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	125	125
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.