Information Collection

Evaluators' Network, Member Survey

IC 241912 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1050 Evaluators' Network, Member Survey	Form
GIC 1050 Survey Invite Primry Blog Post.docx	Instruction
0920-1050 2020 Annual Evaluators' Network Member Survey GIC 1050 Ann Eval Ntwrk Mbr Survey.docx	Form
GIC 1050 Cover Form.docx Request for Approval	IC Document
GIC 1050 Remind Blog Post.docx Evaluators’ Network Member Survey Invitation, Follow-Up Reminder Blog Post	IC Document
GIC 1050 Survey Invite Primry Email.docx Invitational Email	IC Document

IC Title:

Evaluators' Network, Member Survey

Agency IC Tracking Number:

0920-1050-20OL

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	0920-1050	2020 Annual Evaluators' Network Member Survey	GIC 1050 Ann Eval Ntwrk Mbr Survey.docx		Yes	Yes	Fillable Fileable
Instruction			GIC 1050 Survey Invite Primry Blog Post.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 170

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	170	170
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	GIC 1050 Cover Form.docx	05/21/2020
Evaluatorsâ Network Member Survey Invitation, Follow-Up Reminder Blog Post	GIC 1050 Remind Blog Post.docx	05/21/2020
Invitational Email	GIC 1050 Survey Invite Primry Email.docx	05/21/2020

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