Information Collection

Peers recruited

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.