Information Collection

AIM Team Lead self-administered baseline surveys

IC 237413 under ICR 201908-0935-001 · OMB 0935-0246.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0246 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form E AIM Team Lead self-administered baseline surveys	Form
E AIM Team Leads training workshop Attachment E - AIM TEAM LEAD self-administered baseline survey.docx	Form
F Consent form Attachment F AIM Team Lead self-administered baseline consent form.docx	Form and Instruction

IC Title:

AIM Team Lead self-administered baseline surveys

Agency IC Tracking Number:

Is this a Common Form? No

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	E	AIM Team Leads training workshop	Attachment E - AIM TEAM LEAD self-administered baseline survey.docx		Yes	Yes	Fillable Fileable
Form and Instruction	F	Consent form	Attachment F AIM Team Lead self-administered baseline consent form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 258

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	258	258
Annual IC Time Burden (Hours)	85	85
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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