Information Collection

NPIN Questionnaire for New Organizations

IC 223251 under ICR 201911-0920-001 · OMB 0920-0255.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0255 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0255 NPIN Questionnaire for New Organizations Form and Instruction
0920-0255 Questionnaire for New Organizations Att 3A_NPIN Questionnaire for New Organizations.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NPIN Questionnaire for New Organizations	Agency IC Tracking Number:	0920-0255

Is this a Common Form? No		IC Status: Modified

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	0920-0255	Questionnaire for New Organizations	Att 3A_NPIN Questionnaire for New Organizations.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	400	0	400
Annual IC Time Burden (Hours)	54	-46	100
Annual IC Cost Burden (Dollars)	0	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.