Nonresponse Survey

[NCHHSTP] National Syringe Services Program (SSP) Evaluation

Documents and Forms

Document Name Document Type
Nonresponse Survey Form and Instruction
Nonresponse Survey Att 6_Nonresponse Survey Item_final.docx Form and Instruction
Nonresponse Survey Att 6_Nonresponse Survey Item_final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Nonresponse Survey	Agency IC Tracking Number:	0920-1359

Is this a Common Form? Yes		IC Status: Modified

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	n/a	Nonresponse Survey	Att 6_Nonresponse Survey Item_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 600

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,000	520	480
Annual IC Time Burden (Hours)	33	17	16
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.