Information Collection

Screenings 2 Services Challenge: Feedback Survey

IC 246934 under ICR 202105-0970-001 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
GX Prize Challenge Public Input Survey_04-20-21.docx	Other-Survey
GX Prize Challenge Public Input Survey_04-20-21.docx	Other-Survey
Screenings 2 Services Challenge Feedback Survey -4-21-21.docx Fast Track GenIC Submission Form - Screenings 2 Services Challenge: Feedback Survey	IC Document
Screenings 2 Services Challenge Feedback Survey -4-21-21.docx Fast Track GenIC Submission Form - Screenings 2 Services Challenge: Feedback Survey	IC Document

IC Title:

Screenings 2 Services Challenge: Feedback Survey

Agency IC Tracking Number:

OHS

IC Status: Unchanged

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
Other-Survey			GX Prize Challenge Public Input Survey_04-20-21.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track GenIC Submission Form - Screenings 2 Services Challenge: Feedback Survey	Screenings 2 Services Challenge Feedback Survey -4-21-21.docx	04/21/2021

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