Customer Feedback for Raising Healthy Boys

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
Att 1. Focus Group.docx Other-WORD
0920-1050 Participant Screening Form Att 2. Screening .docx Form
Att 3. PIA Raising Healthy Boys (RHB)_signed.pdf PIA_ Raising Healthy Boys IC Document
1050 Generic request Raising Healthy Boys (RHB)_4.3.2020.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Customer Feedback for Raising Healthy Boys	Agency IC Tracking Number:	0920-1050-20MN

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att 1. Focus Group.docx		No		Paper Only
Form	0920-1050	Participant Screening Form	Att 2. Screening .docx		No		Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 216	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	216	216
Annual IC Time Burden (Hours)	154	154
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PIA_ Raising Healthy Boys	Att 3. PIA Raising Healthy Boys (RHB)_signed.pdf	04/15/2020
Request for Approval	1050 Generic request Raising Healthy Boys (RHB)_4.3.2020.docx	04/15/2020

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