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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.