CHC Qualtrics Survey

National Hypertension Control Initiative

OMB: 0990-0482

IC ID: 252914

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Information Collection (IC) Details

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CHC Qualtrics Survey
 
No Unchanged
 
Voluntary
 
5 CFR 1320.8(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-instruction and form Appendix A_Qualtrics and DREaM CHC quarterly survey questions_Final.docx Yes Yes Fillable Fileable

Health Illness Prevention

CHCs: Qualtrics survey   86 FR 70510

350 2
   
Federal Government
 
   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 2,800 0 0 0 0 2,800
Annual IC Time Burden (Hours) 1,050 0 0 0 0 1,050
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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