Information Collection

PRC Indicator Survey

IC 37806 under ICR 201806-0920-012 · OMB 0920-0650.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PRCP Data Collection System PRC Indicator Survey	Form
Form 0920-0650 PRC Program Web-based Data Collection System - REDCap PRC Indicator Survey	Form
PRCP Data Collection System Attachment_4 _Web-based_Data_Collection_System_Screen_Shots_121615.docx	Form
0920-0650 PRC Program Web-based Data Collection System - REDCap Attachment 1 PERS V1 REDCap Year 4-5 Screenshots 2018-06-15.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	none				Yes	Yes	Fillable Fileable
Form	0920-0650			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	26	0	26
Annual IC Time Burden (Hours)	1,066	-182	1,248
Annual IC Cost Burden (Dollars)	0	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.

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