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Organizer Survey for Initial and Follow-up
Assessment of the Underage Drinking Prevention Initiative
OMB: 0930-0288
IC ID: 182093
OMB.report
HHS/SAMHSA
OMB 0930-0288
ICR 202203-0930-005
IC 182093
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0288 can be found here:
2023-10-31 - Revision of a currently approved collection
Documents and Forms
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:
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 %
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
1,000
0
500
0
500
0
Annual IC Time Burden (Hours)
167
0
83
0
84
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.