Information Collection

NCCCP Survey

IC 261239 under ICR 202307-0920-003 · OMB 0920-0841.

Documents and Forms

Document Name Document Type
Form 0920-0841 NCCCP Survey Form and Instruction
0920-0841 NCCCP Survey 0920-0841_Attachment 2e. NCCCP Survey_Data Collection Instrument.docx Form and Instruction
0920-0841 NCCCP Survey 0920-0841_Attachment 2e. NCCCP Survey_Data Collection Instrument.docx Form and Instruction
Attachment 2f_REDCap Screenshots of NCCCP Survey_2023_07.18.pdf NCCCP Survey_REDCap - screenshots IC Document
Attachment 2f_REDCap Screenshots of NCCCP Survey_2023_07.18.pdf NCCCP Survey_REDCap - screenshots IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NCCCP Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	0920-0841	NCCCP Survey	0920-0841_Attachment 2e. NCCCP Survey_Data Collection Instrument.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 44	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	44	44
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NCCCP Survey_REDCap - screenshots	Attachment 2f_REDCap Screenshots of NCCCP Survey_2023_07.18.pdf	07/26/2023

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