Information Collection

SPC Web Survey

IC 227927 under ICR 201708-0930-001 · OMB 0930-0381.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0381 can be found here:

Documents and Forms

Document Name Document Type
Form State PATH Contact SPC Web Survey Form and Instruction
State PATH Contact State PATH Contact Web Survey PATH Evaluation_Attachment1_2017_May1.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SPC Web Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	State PATH Contact Web Survey	State PATH Contact Web Survey	PATH Evaluation_Attachment1_2017_May1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	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
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.