Information Collection

[CGH] Shiriki Virtual Community Annual Planning Survey

IC 264659 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1050 [CGH] Shiriki Virtual Community Annual Planning Survey	Form and Instruction
Form 0920-1050 Shiriki Protocol New Member_Webinar Feedback Form [CGH] Shiriki Virtual Community Annual Planning Survey	Form and Instruction
0920-1050 Shiriki Protocol New Member_Webinar Feedback Form Protocol_Shiriki community_Nov 2023.docx	Form and Instruction
0920-1050 Shiriki Protocol New Member_Webinar Feedback Form Protocol_Shiriki community_Nov 2023.docx	Form and Instruction
0920-1050_Shiriki annual community annual survey.docx 0920-1050 GenIC Request Template	IC Document
0920-1050_Shiriki annual community annual survey.docx 0920-1050 GenIC Request Template	IC Document

IC Title:

[CGH] Shiriki Virtual Community Annual Planning Survey

Agency IC Tracking Number:

0920-1050-24CJ

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	0920-1050			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0920-1050 GenIC Request Template		01/24/2024

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

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