OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

YSI Program Users (Demographic Screener)

IC 204463 under ICR 201210-0920-004 · OMB 0920-0951.

Documents and Forms
Document Name
Document Type
Form
Form
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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YSI Program Users (Demographic Screener)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Demographic Screener Screenshots Att 4A_YSI Program Demographic Screener_10 05 2012.pdf Yes Yes Fillable Fileable

Health Immunization Management

 

500 0
   
Individuals or Households
 
   100 %

  Approved 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 500 0 500 0 0 0
Annual IC Time Burden (Hours) 42 0 42 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
YSI Announcement Att 3A_YSI Announcement_ 9 17 2012.doc 09/27/2012
YSI Landing Page Att 3B_YSI Landing Page_9 17 2012.pdf 09/27/2012
Reminder Email Att 3C_Follow Up Reminder_9 17 2012.doc 09/27/2012
Word Version Demographic Screener Att 4B_Full Version YSI Program Demographic Screener_10 05 2012.doc 10/05/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.