Information Collection

Organizer Survey

IC 182093 under ICR 202310-0930-003 · OMB 0930-0288.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0288 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Organizer Survey Organizer Survey	Form and Instruction
Organizer Survey Organizer Survey 4. Attachment_C_Organizer_Survey_for_Initial_ Mod_Revised_7.10_cleaned.docx	Form and Instruction
Organizer Survey Organizer Survey 4. Attachment_C_Organizer_Survey_for_Initial_ Mod_Revised_7.10_cleaned.docx	Form and Instruction
0930-0288 Communities Talk _ Attachment_2_ICF_IRB_Exempt_Approval.pdf Attachment_2_ICF_IRB_Exempt_Approval	IC Document
0930-0288 Communities Talk _ Attachment_2_ICF_IRB_Exempt_Approval.pdf Attachment_2_ICF_IRB_Exempt_Approval	IC Document
Attachment_E_Organizer_Survey_Email_Invitation_for_Initial_Mod_Revised_6.15_Clean.docx Organizer Survey Email	IC Document
Attachment_E_Organizer_Survey_Email_Invitation_for_Initial_Mod_Revised_6.15_Clean.docx Organizer Survey Email	IC Document

IC Title:

Organizer Survey

Agency IC Tracking Number:

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	Organizer Survey	Organizer Survey	4. Attachment_C_Organizer_Survey_for_Initial_ Mod_Revised_7.10_cleaned.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Organizer Survey for Initial and Follow-up

FR Citation: 75 FR 28264

Number of Respondents: 500

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	Previously Approved
Annual Number of Responses for this IC	500	-500	1,000
Annual IC Time Burden (Hours)	125	-42	167
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment_2_ICF_IRB_Exempt_Approval	0930-0288 Communities Talk _ Attachment_2_ICF_IRB_Exempt_Approval.pdf	03/28/2022
Organizer Survey Email	Attachment_E_Organizer_Survey_Email_Invitation_for_Initial_Mod_Revised_6.15_Clean.docx	10/25/2023

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