Information Collection

Participant Feedback Form

IC 266676 under ICR 202404-0930-003 · OMB 0930-0398.

Documents and Forms

Document Name Document Type
Form Participant Feedba Participant Feedback Form Form and Instruction
Participant Feedba Participant Feedback Form Att.F_PFF for OMB_CLEAN_10242023.docx Form and Instruction
Participant Feedba Participant Feedback Form Att.F_PFF for OMB_CLEAN_10242023.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant Feedback Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Participant Feedback Form	Participant Feedback Form	Att.F_PFF for OMB_CLEAN_10242023.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)	FR Citation: 75 FR 28264

Number of Respondents: 2,775	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
Annual Number of Responses for this IC	2,775	2,775
Annual IC Time Burden (Hours)	416	416
Annual IC Cost Burden (Dollars)	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.