Information Collection

Web-based Surveys

IC 189503 under ICR 200906-0920-003 · OMB 0920-0864.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0864 can be found here:

Documents and Forms

Document Name Document Type
Form no number Web-based Surveys Form
no number Example Web-Based Survey Attachment 6- Example Web Based Survey.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Web-based Surveys	Agency IC Tracking Number:

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	no number	Example Web-Based Survey	Attachment 6- Example Web Based Survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 490	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	490	0	0	0	0	0
Annual IC Time Burden (Hours)	245	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	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.