OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Family-to-Family Health Information Center Feedback Surveys

IC 234425 under ICR 202201-0906-001 · OMB 0906-0040.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Family-to-Family Health Information Center Feedback Surveys
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 F2FHIC_Feedback Surveys Final clean.docx FORM - F2FHIC_Feedback Surveys Final clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

4,000 1,000
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,000 0 2,853 0 0 1,147
Annual IC Time Burden (Hours) 600 0 428 0 0 172
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Feeback Survey Grant Recepient Instructions FeedbackSurvey_GrantRecipient_Instructions.docx 12/06/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.