Family-to-Family Health Information Center Feedback Surveys

Family-to-Family Health Information Center (F2F HIC) Feedback Surveys

Documents and Forms

Document Name Document Type
Form 2 Family-to-Family Health Information Center Feedback Surveys Form and Instruction
2 F2FHIC_Feedback Surveys Final clean.docx FORM - F2FHIC_Feedback Surveys Final clean.docx Form and Instruction
2 F2FHIC_Feedback Surveys Final clean.docx FORM - F2FHIC_Feedback Surveys Final clean.docx Form and Instruction
FeedbackSurvey_GrantRecipient_Instructions.docx Feeback Survey Grant Recepient Instructions IC Document
FeedbackSurvey_GrantRecipient_Instructions.docx Feeback Survey Grant Recepient Instructions IC Document

Information Collection (IC) Details

IC Title:	Family-to-Family Health Information Center Feedback Surveys	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	2	F2FHIC_Feedback Surveys Final clean.docx	FORM - F2FHIC_Feedback Surveys Final clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 1,000

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,000	2,853	1,147
Annual IC Time Burden (Hours)	600	428	172
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.