Information Collection

Nursing Organization Questionnaire

IC 220388 under ICR 202102-0920-003 · OMB 0920-1129.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form nopne Nursing Organization Questionnaire	Form
nopne Nursing Organization Questionnaire Brief Questionnaire for Nursing Organization Memberships (Online).pdf	Form
nopne Nursing Organization Questionnaire Brief Questionnaire for Nursing Organization Memberships (Online).pdf	Form
Brief Questionnaire for Nursing Organization Memberships_Edited.docx Brief Questionnaire for Nursing	IC Document
Brief Questionnaire for Nursing Organization Memberships_Edited.docx Brief Questionnaire for Nursing	IC Document

IC Title:

Agency IC Tracking Number:

17ADN

Is this a Common Form? No

IC Status: Removed

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
Form	nopne	Nursing Organization Questionnaire	Brief Questionnaire for Nursing Organization Memberships (Online).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,934

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-2,934	2,934
Annual IC Time Burden (Hours)	-489	489
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Brief Questionnaire for Nursing	Brief Questionnaire for Nursing Organization Memberships_Edited.docx	05/09/2017

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