Information Collection

NPIN Questionnaire for New Organizations

IC 223251 under ICR 202102-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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
NPIN Questionnaire for New Organizations	Form and Instruction
NPIN Questionnaire for New Organizations NPIN Questionnaire for New Organizations	Form and Instruction
NPIN Questionnaire for New Organizations Att 3A_NPIN Questionnaire for New Organizations_New Question added.docx	Form and Instruction
NPIN Questionnaire for New Organizations Att 3A_NPIN Questionnaire for New Organizations_New Question added.docx	Form and Instruction

IC Title:

NPIN Questionnaire for New Organizations

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
Form and Instruction	none				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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