Information Collection

Wave 1 - SEA Staff Web Survey

IC 238731 under ICR 201910-0920-010 · OMB 0920-1302.

Documents and Forms

Document Name Document Type
Wave 1 - SEA Staff Web Survey Form and Instruction
SEA Implementation Survey Attachment 7 -SEA Web-Based Implementation Survey and Participant Consent.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Wave 1 - SEA Staff Web Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	SEA Implementation Survey	Attachment 7 -SEA Web-Based Implementation Survey and Participant Consent.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3	3
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.