Information Collection

BAA HCP Pre-Campaign web survey

IC 256481 under ICR 202210-0920-006 · OMB 0920-1387.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1387 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-22CC BAA HCP Pre-Campaign web survey	Form and Instruction
0920-22CC BAA HCP Pre Campaign Screener and Survey Attachment E_BAA HCP Pre Campaign Screener and Survey_9.9.22.docx	Form and Instruction
0920-22CC BAA HCP Pre Campaign Screener and Survey Attachment E_BAA HCP Pre Campaign Screener and Survey_9.9.22.docx	Form and Instruction

IC Title:

BAA HCP Pre-Campaign web survey

Agency IC Tracking Number:

0920-22CC

Is this a Common Form? No

IC Status: New

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	0920-22CC	BAA HCP Pre Campaign Screener and Survey	Attachment E_BAA HCP Pre Campaign Screener and Survey_9.9.22.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 788

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	788	788
Annual IC Time Burden (Hours)	263	263
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.