Information Collection

Affiliated Partners Web Survey

IC 213443 under ICR 201410-0925-001 · OMB 0925-0707.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0707 can be found here:

Documents and Forms

Document Name Document Type
Form 2 AFFILIATED PARTNERS WEB SURVEY Form and Instruction
2 AFFILIATED PARTNERS WEB SURVEY Attachment 2 Affiliated Partners Web Survey.8-20-14.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AFFILIATED PARTNERS WEB SURVEY	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	AFFILIATED PARTNERS WEB SURVEY	Attachment 2 Affiliated Partners Web Survey.8-20-14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 71	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	71	71
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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