Information Collection

Stakeholder Needs and Interests Market Survey

IC 223223 under ICR 201608-0920-015 · OMB 0920-1151.

Documents and Forms

Document Name Document Type
Stakeholder Needs and Interests Market Survey Form
Stakeholder Needs and Interests Market Survey Att D-5_Stakeholder Survey Screenshots_8-5-16.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Stakeholder Needs and Interests Market Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	none	Stakeholder Needs and Interests Market Survey	Att D-5_Stakeholder Survey Screenshots_8-5-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 267	Number of Respondents for Small Entity: 214

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	267	267
Annual IC Time Burden (Hours)	89	89
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.