Information Collection

(EGAPP) - Policy Survey - att D4

IC 179076 under ICR 200703-0920-005 · OMB 0920-0751.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0751 can be found here:

Documents and Forms

Document Name Document Type
(EGAPP) - Policy Survey - att D4 Form and Instruction
D4. Policy Survey Attachment D4 Policy Survey.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	(EGAPP) - Policy Survey - att D4	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	None	D4. Policy Survey	Attachment D4 Policy Survey.doc		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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	8	8
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.