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Federal forms, ICRs, and supporting documents

Information Collection

Information Collection Questionnaire (Data Management System)

IC 43628 under ICR 201512-0925-004 · OMB 0925-0348.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Information Collection Questionnaire (Data Management System)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Attachment 2 WTP Data Management System screenshots 0925-0348 Attachment 2 WTP Data Management System screen shots.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

20 0
   
Private Sector Not-for-profit institutions
 
   50 %

  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 40 0 0 0 0 40
Annual IC Time Burden (Hours) 560 0 0 0 0 560
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 1 Information Collection Questionnaire (Data Management System) 0925-0348 Attachment 1 Information Collection Questionnaire (Data Management System).doc 12/23/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.