Information Collection

OER Intercept survey

IC 229073 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⚠️ Notice: This information collection may be referencing outdated material.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 OER Intercept survey	Form
1 OER Intercept Survey questions OER-INTERCEPT SURVEY QUESTIONS.docx	Form
OER_Survey_Clearance (2).doc OER Survey fast track template	IC Document

IC Title:

OER Intercept survey

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	1	OER Intercept Survey questions	OER-INTERCEPT SURVEY QUESTIONS.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,000	12,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OER Survey fast track template	OER_Survey_Clearance (2).doc	11/16/2017

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