Information Collection

Email Verfication Message

IC 223253 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Att 3C_Email Verification.docx	Other-Email
Att 4_Screen_Shots_NPIN Online Questionnaire.docx Online Questionnaire (via email)	IC Document

IC Title:

Email Verfication Message

Agency IC Tracking Number:

0920-0255

Is this a Common Form? No

IC Status: Modified

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
Other-Email			Att 3C_Email Verification.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,600

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	Previously Approved
Annual Number of Responses for this IC	3,600	600	3,000
Annual IC Time Burden (Hours)	480	-120	600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Online Questionnaire (via email)	Att 4_Screen_Shots_NPIN Online Questionnaire.docx	11/04/2019

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