Information Collection

Nonresponse Survey

IC 248418 under ICR 202310-0920-001 · OMB 0920-1359.

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

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.