Information Collection

Puerto Rico BRFSS Coordinator - Data submission

IC 227416 under ICR 201704-0920-008 · OMB 0920-1188.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Puerto Rico BRFSS Coordinator - Data submission	Form and Instruction
Recruitment Script Data Att 2 ZRHCS Recruitment Script.docx	Form and Instruction
Call Back Survey Data Att 3 ZRHCS Survey.DOCX	Form and Instruction

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	NA	Recruitment Script Data	Att 2 ZRHCS Recruitment Script.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Call Back Survey Data	Att 3 ZRHCS Survey.DOCX	NA	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

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	6	6
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.