Information Collection

CCC Program Director Web Survey Questionnaire

IC 210383 under ICR 201510-0920-001 · OMB 0920-1016.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- CCC Program Director Web Survey Questionnaire	Form and Instruction
Att C1b_Program_Director_Survey_Screen_Shots_11_01_13.docx	Instruction
0920- Att C1a _Program_Director_Web_Survey_10_29_13 Att C1a _Program_Director_Web_Survey_10_29_13.docx	Form and Instruction
Att C4_ Program_Director_Reminder_E-Mail_10_29_13.docx Att C4_ Program_Director_Reminder_E-Mail	IC Document
Att C3_Program_Director_Advance_E-Mail_10_29_13.docx Att C3_Program_Director_Advance_E-Mai	IC Document
Att C2 _Program_Director_Advance_Letter_10_29_13.docx Att C2 _Program_Director_Advance_LetterAtt C2 _Program_Director_Advance_Letter	IC Document
Att C5_ Program_Director_Thankyou_E-Mail_10_29_13.docx Att C5_ Program_Director_Thankyou_E-Mail	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	0920-	Att C1a _Program_Director_Web_Survey_10_29_13	Att C1a _Program_Director_Web_Survey_10_29_13.docx		Yes	Yes	Fillable Fileable
Instruction			Att C1b_Program_Director_Survey_Screen_Shots_11_01_13.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 43

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	Previously Approved
Annual Number of Responses for this IC	43	43
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att C4_ Program_Director_Reminder_E-Mail	Att C4_ Program_Director_Reminder_E-Mail_10_29_13.docx	02/11/2014
Att C3_Program_Director_Advance_E-Mai	Att C3_Program_Director_Advance_E-Mail_10_29_13.docx	02/11/2014
Att C2 _Program_Director_Advance_LetterAtt C2 _Program_Director_Advance_Letter	Att C2 _Program_Director_Advance_Letter_10_29_13.docx	02/11/2014
Att C5_ Program_Director_Thankyou_E-Mail	Att C5_ Program_Director_Thankyou_E-Mail_10_29_13.docx	02/11/2014

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