2020 Dietary Primer Assessment and Feedback (NCI)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCI)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Document Name Document Type
Form 1 2020 Dietary Primer Assessment and Feedback (NCI) Form
1 Dietary Primer survey Primer Survey.docx Form
Fast Track Request-Dietary Assessment Primer.docx 2020 Dietary Assessment Primer Survey fast track IC Document
Email.docx email IC Document

Information Collection (IC) Details

IC Title:	2020 Dietary Primer Assessment and Feedback (NCI)	Agency IC Tracking Number:

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	1	Dietary Primer survey	Primer Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2020 Dietary Assessment Primer Survey fast track	Fast Track Request-Dietary Assessment Primer.docx	10/13/2020
email	Email.docx	10/13/2020

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