Information Collection

LEA Collaborative Partner Survey

IC 222151 under ICR 201606-0930-005 · OMB 0930-0364.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LEA CPS LEA Collaborative Partner Survey	Form and Instruction
LEA CPS LEA CPS Attachment 3_OMB_LEA CPS_ ESMHCI_03-22-16.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	LEA CPS	LEA CPS	Attachment 3_OMB_LEA CPS_ ESMHCI_03-22-16.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 930

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	930	930
Annual IC Time Burden (Hours)	465	465
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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