Post-Meeting Survey of Attendees at the 2018 Childhood Lead Poisoning Prevention Annual Cooperative Agreement Recipient's Meeting

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1050 Post-Meeting Survey of Attendees at the 2018 Childhood Lead Poisoning Prevention Annual Cooperative Agreement Recipient's Meeting Form and Instruction
0920-1050 0920-1050 Attachment C - Lead Poisoning Prevention Recipient Meeting Survey_text_AE.docx Form and Instruction
0920-1050 GenIC Request Form.pdf GenIC Request Form IC Document
Attachment A - Email Invite for 2018 Lead Poisoning Prevention Recipient Meeting Survey.docx Email Invite IC Document
Attachment B - Lead Poisoning Prevention Recipient Meeting Survey_screenshot.docx Survey Screen Shots IC Document

Information Collection (IC) Details

IC Title:	Post-Meeting Survey of Attendees at the 2018 Childhood Lead Poisoning Prevention Annual Cooperative Agreement Recipient's Meeting	Agency IC Tracking Number:	0920-1050-19IW

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	0920-1050	0920-1050	Attachment C - Lead Poisoning Prevention Recipient Meeting Survey_text_AE.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Form	0920-1050 GenIC Request Form.pdf	12/14/2018
Email Invite	Attachment A - Email Invite for 2018 Lead Poisoning Prevention Recipient Meeting Survey.docx	12/14/2018
Survey Screen Shots	Attachment B - Lead Poisoning Prevention Recipient Meeting Survey_screenshot.docx	12/14/2018

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