Information Collection

CRCCP Annual Grantees Survey

IC 217152 under ICR 201603-0920-012 · OMB 0920-1074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1074 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CRCCP Annual Grantees Survey	Form
CRCCP Grantee Survey Attachment 3a - CRCCP Annual Grantee Survey (screenshots).pdf	Form
Attachment 3b- Survey Introductory Email.docx Introductory Email	IC Document
Attachment 3c- Survey Reminder Email.docx Reminder Email	IC Document

IC Title:

CRCCP Annual Grantees Survey

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	none	CRCCP Grantee Survey	Attachment 3a - CRCCP Annual Grantee Survey (screenshots).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 31

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	31	31
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Introductory Email	Attachment 3b- Survey Introductory Email.docx	03/28/2016
Reminder Email	Attachment 3c- Survey Reminder Email.docx	03/28/2016

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