Critical Item Survey

National Survey of Community Based Policy and Environmental Supports for Healthy Eating and Active Living

Documents and Forms

Document Name Document Type
Form 0920-20QJ Critical Item Survey Form and Instruction
0920-20QJ Critical Item Survey Attachment 8 - Critical item survey.pdf Form and Instruction
0920-20QJ Critical Item Survey Attachment 8 - Critical item survey.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Critical Item Survey	Agency IC Tracking Number:	0920-20QJ

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	0920-20QJ	Critical Item Survey	Attachment 8 - Critical item survey.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,417	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,417	4,417
Annual IC Time Burden (Hours)	368	368
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.