View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Feedback Survey for Community Counts Data Viz Tool	Agency IC Tracking Number:	0920-1154-23HW

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	0920-1154	Feedback Survey for Community Counts Data Viz Tool	Att1_(genIC) Screenshots of CC Data Viz Feedback Survey_08102023.docx	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

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)	5	0	5	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0920-1154 Supporting Statement A	(genIC) Community Counts Data Viz SSA_08102023__.docx	08/25/2023
0920-1154 Supporting Statement B	(genIC) Community Counts Data Viz SSB_08102023.docx	08/25/2023
GenIC Request Template	(genIC)_Request for Approval CC Data Viz_08102023_sc.docx	08/25/2023

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