NPIN Online Questionnaire for New Organizations

[NCHHSTP] Resources and Services Database of the National Prevention Information Network

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0255 can be found here:

Documents and Forms

Document Name Document Type
NPIN Online Questionnaire for New Organizations Form and Instruction
NPIN Online Questionnaire Att 4_NPIN Online Questionnaire_09142022.docx Form and Instruction
NPIN Online Questionnaire Att 4_NPIN Online Questionnaire_with Mpox Vaccine and Mpox Testing.docx Form and Instruction

Information Collection (IC) Details

IC Title:	NPIN Online Questionnaire for New Organizations	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	None	NPIN Online Questionnaire	Att 4_NPIN Online Questionnaire_with Mpox Vaccine and Mpox Testing.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,605	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,605	-1,995	3,600
Annual IC Time Burden (Hours)	161	-319	480
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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