Information Collection

[NCIPC] Special Emphasis Panel (SEP) Peer Review Evaluation

IC 256874 under ICR 202505-0920-006 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 1_FY23 Peer Review SEP Survey Evaluation Form_v.111422.docx	Other-WORD
Att 1_FY23 Peer Review SEP Survey Evaluation Form_v.111422.docx	Other-WORD
FY23_1050 Request Template Service Delivery_1020 (002).docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-105	IC Document
FY23_1050 Request Template Service Delivery_1020 (002).docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-105	IC Document
FY23 Peer Review SEP Survey_PIA.pdf PIA	IC Document
FY23 Peer Review SEP Survey_PIA.pdf PIA	IC Document

IC Title:

[NCIPC] Special Emphasis Panel (SEP) Peer Review Evaluation

Agency IC Tracking Number:

0920-1050-23AZ

IC Status: Unchanged

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
Other-WORD					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval under the âGeneric Clearance for the Collection of Routine Customer Feedbackâ (OMB Control Number: 0920-1050)		11/14/2022
PIA		11/14/2022

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

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