Information Collection

Building Healthy Military Communities Pilot - Rapid Needs Assessment

IC 229594 under ICR 201712-0704-003 · OMB 0704-0572.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Needs Assessment Meeting Scripts_Public.docx	Other-Questionnaire Script

IC Title:

Agency IC Tracking Number:

0704-AAKS

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
Other-Questionnaire Script			Needs Assessment Meeting Scripts_Public.docx		No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 280

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	280	280
Annual IC Time Burden (Hours)	420	420
Annual IC Cost Burden (Dollars)	13,062	13,062

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.