Information Collection

Project Director Survey

IC 224762 under ICR 201612-0930-004 · OMB 0930-0372.

Documents and Forms

Document Name Document Type
Form PD Survey Project Director Survey Form and Instruction
PD Survey PD Survey AttachA PD Survey 7.29.16.docx Form and Instruction
AttachB IRB_Initial_Determination_Notice_study_exemptv2012.pdf IRB IC Document
AttachC Comment.pdf Comment IC Document
AttachD Response Comment.doc Response Comment IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Project Director 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 and Instruction	PD Survey	PD Survey	AttachA PD Survey 7.29.16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IRB	AttachB IRB_Initial_Determination_Notice_study_exemptv2012.pdf	12/13/2016
Comment	AttachC Comment.pdf	12/13/2016
Response Comment	AttachD Response Comment.doc	12/13/2016

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