Family-to-Family Health Information Centers Data Submission Form

Family-to-Family Health Information Center (F2F HIC) Feedback Surveys

OMB: 0906-0040

IC ID: 234424

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Information Collection (IC) Details

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Family-to-Family Health Information Centers Data Submission Form
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 F2F HIC DataSubmission_Form.docx DataSubmission_Form.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

59 59
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 59 0 59 0 0 0
Annual IC Time Burden (Hours) 5,251 0 5,251 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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