Information Collection

[NCCDPHP] 2023 Annual Evaluators' Network Member Survey

IC 260004 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⚠️ Notice: This information collection may be referencing outdated material.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
[NCCDPHP] 2023 Annual Evaluators' Network Member Survey	Form and Instruction
2023 Annual Evaluators' Network Member Survey [NCCDPHP] 2023 Annual Evaluators' Network Member Survey	Form and Instruction
2023 Annual Evaluators' Network Member Survey 2023 Evaluator Network Survey 04192023.pdf	Form and Instruction
2023 Annual Evaluators' Network Member Survey 2023 Evaluator Network Survey 04192023.pdf	Form and Instruction
0920-1050_Customer_Service_GenIC_Clearance_OSH_Evaluators Network_4.26.23.pdf GENIC Template with Project Description and Burden Estimate	IC Document
0920-1050_Customer_Service_GenIC_Clearance_OSH_Evaluators Network_4.26.23.pdf GENIC Template with Project Description and Burden Estimate	IC Document

IC Title:

[NCCDPHP] 2023 Annual Evaluators' Network Member Survey

Agency IC Tracking Number:

0920-1050-23EO

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
Form and Instruction	None				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 190

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
	Requested	Previously Approved
Annual Number of Responses for this IC	190	190
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GENIC Template with Project Description and Burden Estimate		05/02/2023

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

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