Information Collection

Submission of NQDW Intake Questionnaire Electronic Data File

IC 204102 under ICR 202503-0920-037 · OMB 0920-0856.

Documents and Forms

Document Name Document Type
0856 NQDW Att G2_NQDW SFTP Instructions for States.docx Instruction
0856 NQDW Att G2_NQDW SFTP Instructions for States.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Submission of NQDW Intake Questionnaire Electronic Data File	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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
Instruction			0856 NQDW Att G2_NQDW SFTP Instructions for States.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	216	216
Annual IC Time Burden (Hours)	216	216
Annual IC Cost Burden (Dollars)	5,841	5,841

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.