Information Collection

National DPP Partner Site-Level Rapid Evaluation Survey

IC 241408 under ICR 201910-0920-009 · OMB 0920-1312.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
National DPP Partner Site-Level Rapid Evaluation Survey	Form and Instruction
National DPP Site-Level Rapid Evaluation - Survey Questi Att 4g. NDPP Site Survey_30Day_v2.docx	Form and Instruction

IC Title:

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 and Instruction	n/a	National DPP Site-Level Rapid Evaluation - Survey Questionnaire	Att 4g. NDPP Site Survey_30Day_v2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 340

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	340	340
Annual IC Time Burden (Hours)	170	170
Annual IC Cost Burden (Dollars)	4,590	4,590

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.