Information Collection

WiTS Climate Survey 2015

IC 219000 under ICR 201501-0925-004 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 WiTS Climate Survey 2015	Form and Instruction
1 2015 WiTS Climate Survey 2015_WiTS_Climate_Survey (3).docx	Form and Instruction
FT Template_WiTS Climate Surveys.docx Fast Track WiTS Climate Surveys	IC Document

IC Title:

WiTS Climate Survey 2015

Agency IC Tracking Number:

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	1	2015 WiTS Climate Survey	2015_WiTS_Climate_Survey (3).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	40	40
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track WiTS Climate Surveys	FT Template_WiTS Climate Surveys.docx	11/16/2015

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