Information Collection

BHTCC Stakeholders

IC 220569 under ICR 201603-0930-004 · OMB 0930-0363.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Concept Mapping Br BHTCC Stakeholders	Form and Instruction
Concept Mapping Br Concept Mapping Brainstorming Activity Attachment E_Concept Mapping Brainstorming Activity.docx	Form and Instruction
Concept Mapping So Concept Mapping Sorting and Rating Activity Attachment F_Concept Mapping SortingandRating Activity.docx	Form and Instruction

IC Title:

BHTCC Stakeholders

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	Concept Mapping Brainstorming Activity	Concept Mapping Brainstorming Activity	Attachment E_Concept Mapping Brainstorming Activity.docx		Yes	Yes	Fillable Fileable
Form and Instruction	Concept Mapping Sorting and Rating Activity	Concept Mapping Sorting and Rating Activity	Attachment F_Concept Mapping SortingandRating Activity.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 294

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	474	474
Annual IC Time Burden (Hours)	237	237
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.