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View Information Collection (IC)

View Information Collection (IC)

IC Title:	CRCCP Annual Awardee Survey	Agency IC Tracking Number:	0920-1074

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-1074	CRCCP Annual Awardee Survey	Attachment 4a - CRCCP Annual Awardee Survey (screenshots).docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	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 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	35	0	35	0	0	0
Annual IC Time Burden (Hours)	9	0	9	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 4b - CRCCP Survey Introductory Email	Attachment 4b - CRCCP Survey Introductory Email.docx	05/07/2024
Attachment 4c - CRCCP Survey Reminder Email	Attachment 4c - CRCCP Survey Reminder Email.docx	05/07/2024

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