Information Collection

AFIX Quarterly Call Evaluation

IC 218144 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 1_ AFIX Quarterly Call Evaluation Survey_Screenshots.pdf	Other-Screenshots
GenIC 0920-1026 AFIX Quarterly Call Evaluation.docx Request for Approval	IC Document
Attachment 2_ AFIX Quarterly Call Evaluation Survey_Participation Email.docx Att 2_ AFIX Quarterly Call_Participants Participation Email	IC Document
Attachment 3_ AFIX Quarterly Call Evaluation Survey_Reminder Email.docx Att 3_AFIX Quarterly Call_Participants Follow-up Email	IC Document

IC Title:

Agency IC Tracking Number:

15BFB

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 30 CFR 42

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-Screenshots			Attachment 1_ AFIX Quarterly Call Evaluation Survey_Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	100	100
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	GenIC 0920-1026 AFIX Quarterly Call Evaluation.docx	09/10/2015
Att 2_ AFIX Quarterly Call_Participants Participation Email	Attachment 2_ AFIX Quarterly Call Evaluation Survey_Participation Email.docx	09/10/2015
Att 3_AFIX Quarterly Call_Participants Follow-up Email	Attachment 3_ AFIX Quarterly Call Evaluation Survey_Reminder Email.docx	09/10/2015

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