Information Collection

Organizer Survey

IC 182093 under ICR 201701-0930-002 · OMB 0930-0288.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.