Information Collection

Health Promotion Disease Prevention Activities Registration

IC 248668 under ICR 202201-0917-001 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 9017 Health Promotion Disease Prevention Activities Registration	Form and Instruction
9017 9017 2021 Virtual JMI Survey Monkey Registration_7.01.21.pdf	Form and Instruction
9017 9017 2021 Virtual JMI Survey Monkey Registration_7.01.21.pdf	Form and Instruction
Generic Clearance Submission Template - Health Promotion Disease Prevention Activities Registration (JMI).docx Supporting Statement JMI	IC Document
Generic Clearance Submission Template - Health Promotion Disease Prevention Activities Registration (JMI).docx Supporting Statement JMI	IC Document

IC Title:

Health Promotion Disease Prevention Activities Registration

Agency IC Tracking Number:

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
Form and Instruction	9017	9017	2021 Virtual JMI Survey Monkey Registration_7.01.21.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement JMI	Generic Clearance Submission Template - Health Promotion Disease Prevention Activities Registration (JMI).docx	08/02/2021

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