Information Collection

Cloud Pilot Survey

IC 220615 under ICR 201603-0925-004 · OMB 0925-0743.

Documents and Forms

Document Name Document Type
Form 1 Cloud Pilot Survey Form and Instruction
1 Attachment A - Screen shots Attachment A - Screen Shots.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cloud Pilot Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	1	Attachment A - Screen shots	Attachment A - Screen Shots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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