Information Collection

Peers recruited

IC 204847 under ICR 201606-0925-005 · OMB 0925-0610.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Peers recruited	Form and Instruction
2 Peer Online Survey Attachment 2B Peer Online Survey Screen Shots.doc	Form and Instruction
Attachment 2A Peer Survey Hard Copy.doc Attachment 2A Peer Survey Hard Copy	IC Document

IC Title:

Peers recruited

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	2	Peer Online Survey	Attachment 2B Peer Online Survey Screen Shots.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,535

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,535	2,535
Annual IC Time Burden (Hours)	-1,690	1,690
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 2A Peer Survey Hard Copy	Attachment 2A Peer Survey Hard Copy.doc	11/14/2012

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