Information Collection

Att D1_CRCCP Grantees Sruvey (Screenshots/Layout Preview)

IC 217152 under ICR 201503-0920-001 · OMB 0920-1074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1074 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment D2_CRCCP Grantee Survey_MS Word Version (2).pdf	Other-
Attachment D1_CRCCP Survey Screenshots_061115.pdf	Other-
Attachment F_CRCCP_Survey_FAQ.docx Att F_ CRCCP Survey FAQ	IC Document

IC Title:

Att D1_CRCCP Grantees Sruvey (Screenshots/Layout Preview)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR Public Health Service Act (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Other-					Yes	Yes	Fillable Fileable
Other-					Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 29

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	29	29
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att F_ CRCCP Survey FAQ		06/22/2015

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

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