Organizer Survey

Assessment of the Underage Drinking Prevention Initiative

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.