Information Collection

Web-based Survey of Coalition Members and NCCCP Partners

IC 242185 under ICR 202608-0920-006 · OMB 0920-1193.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-26-0262 Attachment 5f_Web Survey (word) Web-based Survey of Coalition Members and NCCCP Partners	Form
0920-26-0262 Attachment 5f_Web Survey (word) Attachment 5f_Web-Based Survey (MS Word Format).docx	Form
Attachment 5g_Web-Based Survey (Screenshots).docx Attachment 5g_Web-Based Survey (Screenshots)	IC Document

IC Title:

Agency IC Tracking Number:

0920-26-0262

Is this a Common Form? No

IC Status: Modified

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	0920-26-0262				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 44

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	44	44
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 5g_Web-Based Survey (Screenshots)		09/01/2026

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

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