Information Collection

Family-to-Family Health Information Center Feedback Surveys

IC 234425 under ICR 201910-0906-002 · OMB 0906-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Family-to-Family Health Information Center Feedback Surveys	Form and Instruction
2 F2FHIC_FeedbackSurveysForm.docx F2FHIC_FeedbackSurveysForm.docx	Form and Instruction
FeedbackSurvey_GrantRecipient_Instructions.docx Feeback Survey Grant Recepient Instructions	IC Document

IC Title:

Family-to-Family Health Information Center Feedback Surveys

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	2	F2FHIC_FeedbackSurveysForm.docx	F2FHIC_FeedbackSurveysForm.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,147

Number of Respondents for Small Entity: 1,000

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,147	1,147
Annual IC Time Burden (Hours)	172	172
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Feeback Survey Grant Recepient Instructions	FeedbackSurvey_GrantRecipient_Instructions.docx	12/06/2018

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