Information Collection

NCCCP Survey

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

Documents and Forms

Documents and forms in this information collection
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

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:

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	0920-0841	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 %

table that charts list of burden
	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

table that charts IC Documents
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.