Information Collection

[ATSDR] VSP Feedback Survey

IC 273758 under ICR 202411-0923-001 · OMB 0923-0047.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VSP Feedback Survey [ATSDR] VSP Feedback Survey	Form and Instruction
VSP Feedback Survey VSP Feedback Survey_draft_12.17.2024.docx	Form and Instruction
ATSDR 0923-0047 GenlC Request Form_VSP Feedback Survey.docx GenIC Request Template	IC Document
VSP Feedback Survey_email draft.docx Email	IC Document
OMB Control Header and Burden Statement.docx OMB Control Header and Burden Statement	IC Document

IC Title:

Agency IC Tracking Number:

0923-0047-25-0001

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
Form and Instruction	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	500	500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Template		01/17/2025
Email		01/17/2025
OMB Control Header and Burden Statement		01/17/2025

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

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