View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Feedback for 2018 Place & Health Conference	Agency IC Tracking Number:	0920-1050-19AZ

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 and Instruction	0920-1050	Feedback for 2018 Place & Health Conference	Attachment B_Screenshot of Event Feedback Form.docx	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	100	0	100	0	0	0
Annual IC Time Burden (Hours)	8	0	8	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Email / Survey Information	Attachment C_Email with survey.docx	10/15/2018
GenIC Request	GenIC Feedback 2018 Pace and Health Conference-OSsigned.pdf	10/15/2018
Research Determination	NCEH-ATSDR Research Determination Form Signed OS.pdf	10/15/2018

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