Information Collection

CRCCP Annual Awardee Survey

IC 217152 under ICR 202404-0920-011 · OMB 0920-1074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1074 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1074 CRCCP Annual Awardee Survey	Form
0920-1074 CRCCP Annual Awardee Survey Attachment 4a - CRCCP Annual Awardee Survey (screenshots).docx	Form
0920-1074 CRCCP Annual Awardee Survey Attachment 4a - CRCCP Annual Awardee Survey (screenshots).docx	Form
Attachment 4b - CRCCP Survey Introductory Email.docx Attachment 4b - CRCCP Survey Introductory Email	IC Document
Attachment 4b - CRCCP Survey Introductory Email.docx Attachment 4b - CRCCP Survey Introductory Email	IC Document
Attachment 4c - CRCCP Survey Reminder Email.docx Attachment 4c - CRCCP Survey Reminder Email	IC Document
Attachment 4c - CRCCP Survey Reminder Email.docx Attachment 4c - CRCCP Survey Reminder Email	IC Document

IC Title:

CRCCP Annual Awardee Survey

Agency IC Tracking Number:

0920-1074

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	0920-1074	CRCCP Annual Awardee Survey	Attachment 4a - CRCCP Annual Awardee Survey (screenshots).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35

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	35	35
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 4b - CRCCP Survey Introductory Email	Attachment 4b - CRCCP Survey Introductory Email.docx	05/07/2024
Attachment 4c - CRCCP Survey Reminder Email	Attachment 4c - CRCCP Survey Reminder Email.docx	05/07/2024

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