ODP Pathways to Prevention Survey -For Profits

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 ODP Pathways to Prevention Survey -For Profits Form and Instruction
1 Survey Screenshot 2016.2.9. P2P Survey Screen Shots.OMB.final.docx Form and Instruction
Fast Track Template - Pathways to Prevention_revised_For-Profit.doc Fast-Track Template IC Document

Information Collection (IC) Details

IC Title:	ODP Pathways to Prevention Survey -For Profits	Agency IC Tracking Number:

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	1	Survey Screenshot	2016.2.9. P2P Survey Screen Shots.OMB.final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast-Track Template	Fast Track Template - Pathways to Prevention_revised_For-Profit.doc	03/15/2016

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