Information Collection

GDTA Survey

IC 215840 under ICR 201503-0930-002 · OMB 0930-0350.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form GDTA Survey GDTA Survey	Form and Instruction
GDTA Survey GDTA Survey GDTA Attachment A 12-18-14.docx	Form and Instruction
GDTA Attachment B 12-18-14.docx Email Invitation to Project Directors	IC Document
GDTA Attachment C 12-18-14.docx Screen Shots	IC Document

IC Title:

GDTA Survey

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	GDTA Survey	GDTA Survey	GDTA Attachment A 12-18-14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,670

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	2,670	2,670
Annual IC Time Burden (Hours)	267	267
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email Invitation to Project Directors	GDTA Attachment B 12-18-14.docx	03/25/2015
Screen Shots	GDTA Attachment C 12-18-14.docx	03/25/2015

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