Government Official (city, town, county)

Baseline Let's Move! Cities, Towns and Counties Participant Survey

Documents and Forms

Document Name Document Type
Final Baseline Survey_LMCTC 11012.docx Other-Survey
0990-Let's Move! Cities Towns and Countries MEMO.pdf 0990-Let's Move! Cities Towns and Countries MEMO IC Document

Information Collection (IC) Details

IC Title:	Government Official (city, town, county)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Other-Survey			Final Baseline Survey_LMCTC 11012.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-1,000	1,000
Annual IC Time Burden (Hours)	-250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0990-Let's Move! Cities Towns and Countries MEMO	0990-Let's Move! Cities Towns and Countries MEMO.pdf	01/05/2012

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