Information Collection

BAA HCP Post-Campaign web survey

IC 256482 under ICR 202306-0920-012 · OMB 0920-1387.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BAA HCP Post-Campaign web survey	Form and Instruction
BAA HCP Post-Campaign web survey	Form and Instruction
BAA HCP Post Campaign Screener and Survey BAA HCP Post-Campaign web survey.docx	Form and Instruction
BAA HCP Post Campaign Screener and Survey BAA HCP Post-Campaign web survey.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-22CC

Is this a Common Form? No

IC Status: Modified

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	n/a	BAA HCP Post Campaign Screener and Survey	BAA HCP Post-Campaign web survey.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: 100 %

table that charts list of burden
	Approved	Previously Approved
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.