Information Collection

Web-based Partner Survey

IC 233843 under ICR 201811-0920-001 · OMB 0920-1250.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Web-based Partner Survey	Form
Partner Survey Att 3c_ Web-based Partner Survey.docx	Form
Partner Survey - screenshots Att 3d_ Screenshots of Web-based Partner Survey.docx	Form

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	none	Partner Survey	Att 3c_ Web-based Partner Survey.docx		Yes	Yes	Fillable Fileable
Form	none	Partner Survey - screenshots	Att 3d_ Screenshots of Web-based Partner Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	40	40
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	287	287

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.