Organizer Survey

Assessment of the Underage Drinking Prevention: Town Hall Meetings Initiative

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0288 can be found here:

Documents and Forms

Document Name Document Type
Form Organizer Survey Organizer Survey Form and Instruction
Organizer Survey Organizer Survey Attachment 1 - Organizer Survey_10-13-16.doc Form and Instruction
Attachment 7 - Initial E-Mail to Organizers_Organizer Survey_10-13-16.docx Initial Email IC Document
Attachment 8 - Reminder E-Mail to Organizers_Organizer Survey_10-13-16.docx Reminder Email IC Document
Attachment 5 - ICF IRB Review Findings Form_10-13-16.pdf ICF IRB IC Document

Information Collection (IC) Details

IC Title:	Organizer Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Organizer Survey	Organizer Survey	Attachment 1 - Organizer Survey_10-13-16.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	Previously Approved
Annual Number of Responses for this IC	500	-1,720	2,220
Annual IC Time Burden (Hours)	84	-655	739
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Initial Email	Attachment 7 - Initial E-Mail to Organizers_Organizer Survey_10-13-16.docx	01/19/2017
Reminder Email	Attachment 8 - Reminder E-Mail to Organizers_Organizer Survey_10-13-16.docx	01/19/2017
ICF IRB	Attachment 5 - ICF IRB Review Findings Form_10-13-16.pdf	01/19/2017

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