Special Emphasis Panel (SEP) Peer Review Evaluation

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
Form 17WN Special Emphasis Panel (SEP) Peer Review Evaluation Form and Instruction
17WN Att 1. Instrument_Peer Reviewers' Evaluation Form 3.2.17 Att 1. Instrument_Peer Reviewers' Evaluation Form 3.2.17.docx Form and Instruction
Service 1050 GenIC Request_Peer Review Evaulation 3.2.17.docx Service 1050 GenIC Request_Peer Review Evaulation 3.2.17 IC Document

Information Collection (IC) Details

IC Title:	Special Emphasis Panel (SEP) Peer Review Evaluation	Agency IC Tracking Number:	17WN

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	17WN	Att 1. Instrument_Peer Reviewers' Evaluation Form 3.2.17	Att 1. Instrument_Peer Reviewers' Evaluation Form 3.2.17.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 350	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Service 1050 GenIC Request_Peer Review Evaulation 3.2.17	Service 1050 GenIC Request_Peer Review Evaulation 3.2.17.docx	03/02/2017

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