Information Collection

Learn the Signs. Act Early Bulk Orders

IC 223249 under ICR 201410-0920-001 · OMB 0920-0919.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att1 Bulk Order Survey_tjj.docx	Other-WORD
Att3.Screen Shots of Bulk Order Survey_tjj.docx	Other-Screenshots
Sup Sta A_ LTSAE Bulk Orders REVISED_CJP8-28-16_clean.docx Request for Approval/SupSta A	IC Document
Sup_Sta Part_B_for_BULK_ORDERS REVISED_ CJP8-28-16_clean.docx SupSta B	IC Document
Att2.Survey Invitation Email for Bulk Orders.docx Att 2_Survey Invitation Email	IC Document
Att4.Survey Monkey 3rd party SSP for Bulk Orders of Survey.pdf Att 4_Social Media or 3rd Party Site Security Survey/Plan	IC Document
Att5.Bulk Order IRB Non-Research Determination.pdf Att 5_ IRB_Non-research	IC Document

IC Title:

Agency IC Tracking Number:

16BAY

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
Other-WORD			Att1 Bulk Order Survey_tjj.docx		Yes	Yes	Paper Only
Other-Screenshots			Att3.Screen Shots of Bulk Order Survey_tjj.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,240

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	3,240	3,240
Annual IC Time Burden (Hours)	270	270
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval/SupSta A	Sup Sta A_ LTSAE Bulk Orders REVISED_CJP8-28-16_clean.docx	08/29/2016
SupSta B	Sup_Sta Part_B_for_BULK_ORDERS REVISED_ CJP8-28-16_clean.docx	08/29/2016
Att 2_Survey Invitation Email	Att2.Survey Invitation Email for Bulk Orders.docx	08/29/2016
Att 4_Social Media or 3rd Party Site Security Survey/Plan	Att4.Survey Monkey 3rd party SSP for Bulk Orders of Survey.pdf	08/29/2016
Att 5_ IRB_Non-research	Att5.Bulk Order IRB Non-Research Determination.pdf	08/29/2016

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