Information Collection

Webinar 1 Feedback Form

IC 257210 under ICR 202604-0920-002 · OMB 0920-1396.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 920-22HN Webinar 1 Feedback Form Webinar 1 Feedback Form	Form and Instruction
920-22HN Webinar 1 Feedback Form Attachment D_SBAS_Webinar 1 Feedback Form.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-22HN

Is this a Common Form? Yes

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	920-22HN				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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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