Information Collection

Feedback for 2018 Place & Health Conference

IC 233529 under ICR 201605-0920-001 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1050 Feedback for 2018 Place & Health Conference	Form and Instruction
0920-1050 Feedback for 2018 Place & Health Conference Attachment B_Screenshot of Event Feedback Form.docx	Form and Instruction
Attachment C_Email with survey.docx Email / Survey Information	IC Document
GenIC Feedback 2018 Pace and Health Conference-OSsigned.pdf GenIC Request	IC Document
NCEH-ATSDR Research Determination Form Signed OS.pdf Research Determination	IC Document

IC Title:

Feedback for 2018 Place & Health Conference

Agency IC Tracking Number:

0920-1050-19AZ

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	0920-1050	Feedback for 2018 Place & Health Conference	Attachment B_Screenshot of Event Feedback Form.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email / Survey Information	Attachment C_Email with survey.docx	10/15/2018
GenIC Request	GenIC Feedback 2018 Pace and Health Conference-OSsigned.pdf	10/15/2018
Research Determination	NCEH-ATSDR Research Determination Form Signed OS.pdf	10/15/2018

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