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Federal forms, ICRs, and supporting documents

Information Collection

Learn the Signs. Act Early. Customization of Materials Customer Feedback Survey

IC 225377 under ICR 201410-0920-001 · OMB 0920-0919.

Documents and Forms
Document Name
Document Type
Other-WORD
Other-ScreenShots
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Learn the Signs. Act Early. Customization of Materials Customer Feedback Survey 17OM
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att1.Customized Materials Survey.docx Yes Yes Fillable Fileable
Other-ScreenShots Att3.Screen Shots of Customized Materials Survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

252 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 252 0 252 0 0 0
Annual IC Time Burden (Hours) 21 0 21 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A Sup Sta A_LTSAE Customized Materials.docx 01/26/2017
Supporting Statement B Sup_Sta Part_B_for_BULK_ORDERS REVISED 8-28-16.docx 01/26/2017
Att 2_Invitation Email Att2 Survey Invitation Email for Customized Materials.docx 01/26/2017
Request for Determination of Research Status Att6.Bulk Order IRB Non-Research Determination.pdf 01/26/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.