Information Collection

New Beginnings Assessment Survey (Private Sector)

IC 213582 under ICR 201410-0920-026 · OMB 0920-1055.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
New Beginnings Assessment Survey (Private Sector)	Form and Instruction
Attachment 4a New Beginnings Survey Screenshots Attachment 4a- NBWeb Survey Screenshots_031615.docx	Form and Instruction
Attachment 4b NB Survey Advance Email.docx Attachment 4b NB Survey Advance Email	IC Document
Attachment 4c NB Reminder Email.docx Attachment 4c NB Reminder Email	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	None	Attachment 4a New Beginnings Survey Screenshots	Attachment 4a- NBWeb Survey Screenshots_031615.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	700	700
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 4b NB Survey Advance Email	Attachment 4b NB Survey Advance Email.docx	10/22/2014
Attachment 4c NB Reminder Email	Attachment 4c NB Reminder Email.docx	10/22/2014

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