View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Eye Health My Health Community Member Surveys (NEI)	Agency IC Tracking Number:

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	1	EHMH Community member Pre-Survey	Attachment A_EHMH Community Member_Revised Pre-Survey.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	EHMH Community member Post-Survey	Attachment B_EHMH Community Member_Revised Post-Survey.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

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	200	0	200	0	0	0
Annual IC Time Burden (Hours)	24	0	24	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Mini SSA for EHMH survey	Mini SSA for Citizen Science_EHMH Community Member Surveys_Revised_2023.03.22.docx	03/28/2023

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