Client Survey (Participant)

[NCHHSTP] Evaluation of Safe Spaces in CDC-directly funded Community-based Organizations (CBOs)

OMB: 0920-1403

IC ID: 257786

Information Collection (IC) Details

View Information Collection (IC)

Client Survey (Participant) 0920-22IJ
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920- Client Survey Att 4_Participant Survey.docx No   Fillable Fileable

Health Public Health Monitoring

 

1,000 0
   
Individuals or Households
 
   0 %

  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 1,000 0 0 0
Annual IC Time Burden (Hours) 250 0 250 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Client Survey (Participant) Att 4a_Participant Survey Screenshots.docx 01/06/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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