View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	2018 NPIN Web-based Survey	Agency IC Tracking Number:	0920-1027-18ACL

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	none	NPIN Survey Screener	Att1 NPIN Evaluation Screener.docx		Yes	Yes	Fillable Fileable
Form	none	NPIN Survey - word	Att3 2018-NPIN Eval Survey.docx		Yes	Yes	Fillable Fileable
Form	none	NPIN Survey - screenshots	Att3 NPIN Survey Screen shots.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,120	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	12,120	0	12,120	0	0	0
Annual IC Time Burden (Hours)	260	0	260	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	2018 NPIN EvaluationSurvey_FastTrack ShortForm-05-03-2018.docx	05/03/2018
Consent	Att2 NPIN Eval Survey Consent Form-5-3-2018.docx	05/03/2018
Sampling Frame	Att4 NPIN Sampling Frame Final.docx	05/03/2018

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