View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Evaluators' Network, Member Survey	Agency IC Tracking Number:	0920-1050-22FE

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	Network Member Survey	2022 Annual Evaluators' Network Member Survey_5.9.22.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: 229	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	229	0	229	0	0	0
Annual IC Time Burden (Hours)	57	0	57	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Template	0920-1050_Customer_Service_GenIC_Clearance_OSH_Evaluators Network_5.9.22.pdf	05/09/2022

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