DATA CoIIN

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 DATA CoIIN Form
1 DATA CoIIN_Platform Training Survey_042018.pdf DATA CoIIN_Platform Training Survey_042018.pdf Form
Final GENERIC - Supporting Statement_DATA CoIIN_Revised 5-4-18.docx Supporting Statement Revised IC Document

Information Collection (IC) Details

IC Title:	DATA CoIIN	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	1	DATA CoIIN_Platform Training Survey_042018.pdf	DATA CoIIN_Platform Training Survey_042018.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 170	Number of Respondents for Small Entity: 13

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	340	340
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement Revised	Final GENERIC - Supporting Statement_DATA CoIIN_Revised 5-4-18.docx	05/04/2018

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