Information Collection

Title X Outreach and Enrollment (O/E) Progress Report

IC 214237 under ICR 201412-0990-001 · OMB 0990-0423.

Documents and Forms

Document Name Document Type
0990-0243Online Survey Tool O&E Progress Report.pdf Other-online survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Title X Outreach and Enrollment (O/E) Progress Report	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
Other-online survey			0990-0243Online Survey Tool O&E Progress Report.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,200	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,200	4,200
Annual IC Time Burden (Hours)	840	840
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.