Information Collection

[NCCDPHP] 2024 Evaluators' Network, Member Survey

IC 267516 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⚠️ Notice: This information collection may be referencing outdated material.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] 2024 Evaluators' Network, Member Survey	Form and Instruction
2024 Evaluator Network Survey [NCCDPHP] 2024 Evaluators' Network, Member Survey	Form and Instruction
2024 Evaluator Network Survey 2024 Evaluator Network Survey 05072024.pdf	Form and Instruction
2024 Evaluator Network Survey 2024 Evaluator Network Survey 05072024.pdf	Form and Instruction
0920-1050_Customer_Service_GenIC_Clearance_OSH_Evaluators Network_5.7.24.pdf GenIC Request Template	IC Document
0920-1050_Customer_Service_GenIC_Clearance_OSH_Evaluators Network_5.7.24.pdf GenIC Request Template	IC Document

IC Title:

[NCCDPHP] 2024 Evaluators' Network, Member Survey

Agency IC Tracking Number:

0920-1050-24FP

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	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: 187

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	187	187
Annual IC Time Burden (Hours)	31	31
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Template		05/08/2024

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

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