Information Collection

Invitation to Complete the Annual Technical Assistance Survey (email)

IC 271244 under ICR 202409-0920-011 · OMB 0920-1355.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att. 7 Email Invitation Annual Technical Assistance Survey.docx	Instruction
Att. 7 Email Invitation Annual Technical Assistance Survey.docx	Instruction

IC Title:

Agency IC Tracking Number:

0920-1355

Is this a Common Form? No

IC Status: New

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
Instruction					No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 900

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	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.

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