Information Collection

Project Director Survey

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

Documents and Forms

Documents and forms in this information collection
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

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.