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CCC Staff Key Informant Selection
Experiences with the Implementation and Outcomes of Policy and Environmental Cancer Control Interventions
OMB: 0920-1016
IC ID: 210384
OMB.report
HHS/CDC
OMB 0920-1016
ICR 201510-0920-001
IC 210384
( )
Documents and Forms
Document Name
Document Type
Form 0920-
CCC Staff Key Informant Selection
Form and Instruction
0920- Att D3_Key_Informant_Selection_10_29_13
Att D3_Key_Informant_Selection_10_29_13.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CCC Staff Key Informant Selection
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
Form and Instruction
0920-
Att D3_Key_Informant_Selection_10_29_13
Att D3_Key_Informant_Selection_10_29_13.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2
0
0
0
0
2
Annual IC Time Burden (Hours)
16
0
0
0
0
16
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.