Information Collection

Post-Meeti Survey of attendees at the APPLETREE Meeting 2017

IC 226803 under ICR 201510-0923-001 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 17AIX Post-Meeti Survey of attendees at the APPLETREE Meeting 2017	Form and Instruction
17AIX Attachment B - APPLETREE Post Meeting Survey_screenshot Attachment B - APPLETREE Post Meeting Survey_screenshot.pdf	Form and Instruction
17AIX Attachment C - APPLETREE Post Meeting Survey_text Attachment C - APPLETREE Post Meeting Survey_text.docx	Form and Instruction
GenIC Request Form _APPLETREE Meeting 2017.pdf GenIC Request Form _APPLETREE Meeting 2017	IC Document
Attachment A - Email Invite for the APPLETREE Meeting Feedback.docx Attachment A - Email Invite for the APPLETREE Meeting Feedback	IC Document

IC Title:

Post-Meeti Survey of attendees at the APPLETREE Meeting 2017

Agency IC Tracking Number:

17AIX

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	17AIX	Attachment B - APPLETREE Post Meeting Survey_screenshot	Attachment B - APPLETREE Post Meeting Survey_screenshot.pdf		Yes	Yes	Fillable Printable
Form and Instruction	17AIX	Attachment C - APPLETREE Post Meeting Survey_text	Attachment C - APPLETREE Post Meeting Survey_text.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

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	90	90
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Form _APPLETREE Meeting 2017	GenIC Request Form _APPLETREE Meeting 2017.pdf	05/11/2017
Attachment A - Email Invite for the APPLETREE Meeting Feedback	Attachment A - Email Invite for the APPLETREE Meeting Feedback.docx	05/11/2017

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