Information Collection

Information Collection Questionnaire (Data Management System)

IC 43628 under ICR 202602-0925-002 · OMB 0925-0348.

Documents and Forms

Document Name Document Type
Form 1 survey instrument Information Collection Questionnaire (Data Management System) Form and Instruction
1 survey instrument Attachment 1 - WTP Survey Instrument 2022- screen shots v2 (3).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Information Collection Questionnaire (Data Management System)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	survey instrument	Attachment 1 - WTP Survey Instrument 2022- screen shots v2 (3).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-25-0036: Extramural Awards and Chartered Advisory Committees: IMPAC 2 (Grant/Contract/Cooperative Agreement/Chartered Advisory Committee Information), HHS/NIH/OER and HHS/NIH/CM	FR Citation: 67 FR 60742

Number of Respondents: 19	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	38	38
Annual IC Time Burden (Hours)	608	608
Annual IC Cost Burden (Dollars)	0	0

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.

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