Information Collection

Customer Feedback for Raising Healthy Boys

IC 241346 under ICR 201902-0920-022 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.