Information Collection

Att D1_CRCCP Grantees Sruvey (Screenshots/Layout Preview)

IC 217152 under ICR 201503-0920-001 · OMB 0920-1074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1074 can be found here:

Documents and Forms

Document Name Document Type
Attachment D2_CRCCP Grantee Survey_MS Word Version (2).pdf Other-null
Attachment D1_CRCCP Survey Screenshots_061115.pdf Other-null
Attachment F_CRCCP_Survey_FAQ.docx Att F_ CRCCP Survey FAQ IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att D1_CRCCP Grantees Sruvey (Screenshots/Layout Preview)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR Public Health Service Act (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-null			Attachment D2_CRCCP Grantee Survey_MS Word Version (2).pdf		Yes	Yes	Fillable Fileable
Other-null			Attachment D1_CRCCP Survey Screenshots_061115.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	29	29
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att F_ CRCCP Survey FAQ	Attachment F_CRCCP_Survey_FAQ.docx	06/22/2015

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