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

View Information Collection (IC)

SLPHERLT 0920-0879-19TH
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0879 NA Yes Yes Fillable Fileable
Form and Instruction 0920-0879 NA No   Fillable Fileable

Health Consumer Health and Safety

 

762 0
   
State, Local, and Tribal Governments
 
   96 %

  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 762 0 762 0 0 0
Annual IC Time Burden (Hours) 283 0 283 0 0 0
Annual IC Cost Burden (Dollars) 12,217 0 12,217 0 0 0

Title Document Date Uploaded
SSA 02/12/2019
SSB 02/12/2019
Respondent Universe 02/12/2019
Sample of Respondents 02/12/2019
Web-Based Assessment Web Version 02/12/2019
PHEP Director Invitation Email 02/12/2019
Local Invitation Email 02/12/2019
Web One-Page Factsheet 02/12/2019
PHEP Director Reminder Email 02/12/2019
Local Reminder Email 02/12/2019
Generic Focus Group Invitation Email 02/12/2019
Focus Group One-Page Factsheet 02/12/2019
Focus Group Enrollment and Waiver Form 02/12/2019
Focus Group Participation Confirmation Email 02/12/2019
Focus Group Reminder Call Script 02/12/2019
Focus Group Conduct Reminder Email 02/12/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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