Information Collection

Regional Extenion Center

IC 195150 under ICR 201705-0955-001 · OMB 0955-0009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990- REC Operation Plan Template RECs.xls	Other-crm tools
0955-0009 Workforce Survey_v9_2016.doc	Other-survey
0990-REC CRM Tool Screenshots.doc 0990-REC CRM Tool Screenshots	IC Document

IC Title:

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
Other-crm tools			0990- REC Operation Plan Template RECs.xls		No	No	Paper Only
Other-survey			0955-0009 Workforce Survey_v9_2016.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	875	155	0	720
Annual IC Time Burden (Hours)	1,313	0	233	1,080
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-REC CRM Tool Screenshots	0990-REC CRM Tool Screenshots.doc	10/21/2010

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