Information Collection

Knowledge Application Program Product

IC 218767 under ICR 201406-0930-006 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form KAP Survey Knowledge Application Program Product	Form and Instruction
KAP Survey KAP Survey KAP_Customer_Survey_10-28-15.docx	Form and Instruction
KAP_OMB_Proposal_10-28-15.docx Justification	IC Document
Trans.Let-6-2015.doc Transmittal Letter	IC Document

IC Title:

Knowledge Application Program Product

Agency IC Tracking Number:

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	KAP Survey	KAP Survey	KAP_Customer_Survey_10-28-15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	500	500
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	KAP_OMB_Proposal_10-28-15.docx	10/29/2015
Transmittal Letter	Trans.Let-6-2015.doc	10/29/2015

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