Information Collection

PPOD Guide & Toolkit Survey (State and Local Government Sector)

IC 213585 under ICR 201410-0920-026 · OMB 0920-1055.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-14VL PPOD Guide & Toolkit Survey (State and Local Government Sector)	Form and Instruction
0920-14VL Attachment 3a PPOD Survey Screen Shots Attachment 3a PPOD Survey Screen Shots.docx	Form and Instruction
Attachment 3b PPOD Survey Advance Email.doc Attachment 3b PPOD Survey Advance Email	IC Document
Attachment 3c PPOD Reminder Email.docx Attachment 3c PPOD Reminder Email	IC Document

IC Title:

Agency IC Tracking Number:

0920-14VL

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	0920-14VL	Attachment 3a PPOD Survey Screen Shots	Attachment 3a PPOD Survey Screen Shots.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

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	80	80
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
Attachment 3b PPOD Survey Advance Email	Attachment 3b PPOD Survey Advance Email.doc	10/22/2014
Attachment 3c PPOD Reminder Email	Attachment 3c PPOD Reminder Email.docx	10/22/2014

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