View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Survey of State and Territorial Asthma Program Evaluators
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Web Survey of Asthma Program Evaluators Asthma ETA Attachment B- Data Collection Instrument Part 1&2 web version 081811.docx Yes Yes Fillable Fileable
Form none Word version of Survey of Asthma Program Evaluators Asthma ETA Attachment C- Data Collection Instrument Part 1&2 Word version 081811.docx Yes Yes Fillable Fileable

Health Immunization Management

 

36 0
   
State, Local, and Tribal Governments
 
   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 36 0 0 0 0 0
Annual IC Time Burden (Hours) 18 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att D - Intro Email Asthma ETA Attachment D - Introductory Email 081811.docx 08/25/2011
Att E - Reminders Asthma ETA Attachment E - Reminders 081811.docx 08/25/2011
Att F - Follow-up Email Asthma ETA Attachment F - follow up email 081811.docx 08/25/2011
Att G - Self-assessment follow-up Asthma ETA Attachment G- Evaluator Self Assessment Follow up 081811.docx 08/25/2011
Att H - Sample reports Asthma ETA Attachment H- Sample Report 081811.docx 08/25/2011
Supporting Statement A Asthma ETA Supporting Statement Part A 081118.docx 08/25/2011
Supporting Statement B Asthma ETA Supporting Statement Part B 081811.docx 08/25/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.