Information Collection

Ohio Health/T.O.P.P.

IC 201758 under ICR 201502-0990-002 · OMB 0990-0382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0382Attachment B_OHIO.pdf	Other-survey
2_OhioHealth PPA FU _response to OMB_051412.docx	Other-Survey
Instrument 4_OhioHealth FollowUp Survey.pdf	Other-survey

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey	0990-0382Attachment B_OHIO.pdf	Yes	Yes	Printable Only
Other-Survey	2_OhioHealth PPA FU _response to OMB_051412.docx	Yes	Yes	Printable Only
Other-survey	Instrument 4_OhioHealth FollowUp Survey.pdf	No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 148

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	Previously Approved
Annual Number of Responses for this IC	444	-66	510
Annual IC Time Burden (Hours)	311	-46	357
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.