Information Collection

Organizer Survey for Initial and Follow-up

IC 182093 under ICR 202203-0930-005 · OMB 0930-0288.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0288 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Organizer Survey f Organizer Survey for Initial and Follow-up	Form and Instruction
Organizer Survey f Organizer Survey for Initial and Follow-up 0930-0288 Communities Talk _ Attachment_1_Organizer_Survey_for_Initial_and_Follow-Up_09-16-21.docx	Form and Instruction
Organizer Survey f Organizer Survey for Initial and Follow-up 0930-0288 Communities Talk _ Attachment_1_Organizer_Survey_for_Initial_and_Follow-Up_09-16-21.docx	Form and Instruction
0930-0288 Communities Talk _ Attachment_1A_Organizer_Survey_Email_Invitation_for_Initial_09-16-21.docx Organizer_Survey_Email_Invitation_for_Initia	IC Document
0930-0288 Communities Talk _ Attachment_1A_Organizer_Survey_Email_Invitation_for_Initial_09-16-21.docx Organizer_Survey_Email_Invitation_for_Initia	IC Document
0930-0288 Communities Talk _ Attachment_1B_Organizer_Survey_Email_Invitation_for_Follow_Up_09-16-21.docx Organizer_Survey_Email_Invitation_for_Follow_Up	IC Document
0930-0288 Communities Talk _ Attachment_1B_Organizer_Survey_Email_Invitation_for_Follow_Up_09-16-21.docx Organizer_Survey_Email_Invitation_for_Follow_Up	IC Document
0930-0288 Communities Talk _ Attachment_1C_Organizer_Survey_Email_Reminder_for_Initial_and_Follow-Up_09-16-21.docx Organizer_Survey_Email_Reminder_for_Initial_and_Follow-Up	IC Document
0930-0288 Communities Talk _ Attachment_1C_Organizer_Survey_Email_Reminder_for_Initial_and_Follow-Up_09-16-21.docx Organizer_Survey_Email_Reminder_for_Initial_and_Follow-Up	IC Document
0930-0288 Communities Talk _ Attachment_2_ICF_IRB_Exempt_Approval.pdf Attachment_2_ICF_IRB_Exempt_Approval	IC Document
0930-0288 Communities Talk _ Attachment_2_ICF_IRB_Exempt_Approval.pdf Attachment_2_ICF_IRB_Exempt_Approval	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Organizer Survey for Initial and Follow-up

Agency IC Tracking Number:

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	Organizer Survey for Initial and Follow-up	Organizer Survey for Initial and Follow-up	0930-0288 Communities Talk _ Attachment_1_Organizer_Survey_for_Initial_and_Follow-Up_09-16-21.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Organizer Survey for Initial and Follow-up

FR Citation: 75 FR 28264

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,000	500	500
Annual IC Time Burden (Hours)	167	83	84
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Organizer_Survey_Email_Invitation_for_Initia	0930-0288 Communities Talk _ Attachment_1A_Organizer_Survey_Email_Invitation_for_Initial_09-16-21.docx	03/28/2022
Organizer_Survey_Email_Invitation_for_Follow_Up	0930-0288 Communities Talk _ Attachment_1B_Organizer_Survey_Email_Invitation_for_Follow_Up_09-16-21.docx	03/28/2022
Organizer_Survey_Email_Reminder_for_Initial_and_Follow-Up	0930-0288 Communities Talk _ Attachment_1C_Organizer_Survey_Email_Reminder_for_Initial_and_Follow-Up_09-16-21.docx	03/28/2022
Attachment_2_ICF_IRB_Exempt_Approval	0930-0288 Communities Talk _ Attachment_2_ICF_IRB_Exempt_Approval.pdf	03/28/2022

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