Information Collection

Institutional Awareness and Commitment Survey (Partner Organizations)

IC 210318 under ICR 201405-0920-009 · OMB 0920-1010.

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:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	Previously Approved
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.