Information Collection

Information Collection Questionnaire (Data Management System)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0348 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Information Collection Questionnaire (Data Management System)	Form and Instruction
1 Attachment 2 WTP Data Management System screenshots 0925-0348 Attachment 2 WTP Data Management System screen shots.docx	Form and Instruction
0925-0348 Attachment 1 Information Collection Questionnaire (Data Management System).doc Attachment 1 Information Collection Questionnaire (Data Management System)	IC Document

IC Title:

Information Collection Questionnaire (Data Management System)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	Attachment 2 WTP Data Management System screenshots	0925-0348 Attachment 2 WTP Data Management System screen shots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	560	560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.