Post-Meeti Survey of attendees at the APPLETREE Meeting 2017

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.