Information Collection

Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement

IC 244975 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⚠️ Notice: This information collection may be referencing outdated material.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 Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement	Form
0920-1050 Post Site Visit Survey Post site visit survey questions_Clearance.docx	Form
0920-1050-Customer Service GenIC Clearance Template (Final 5.3)_Post visit survey_US NAC_201216.docx Customer Service Clearance Template	IC Document

IC Title:

Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement

Agency IC Tracking Number:

0920-1050-21BR

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	Post Site Visit Survey	Post site visit survey questions_Clearance.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Customer Service Clearance Template	0920-1050-Customer Service GenIC Clearance Template (Final 5.3)_Post visit survey_US NAC_201216.docx	12/17/2020

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