View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	2023 NIAMS Coalition Outreach & Education Meeting Living With Materials Survey	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	1	Survey (Word Version)	Attachment A_O&E Day_Living With Survey.docx		Yes	Yes	Paper Only
Form	2	Survey (Screenshots)	Attachment B_Survey Screenshots.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: 32	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	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	32	0	32	0	0	0
Annual IC Time Burden (Hours)	3	0	3	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Template	OMB FORM_NIAMS_O&E Day Living With Survey.docx	09/12/2023
QR Code	Attachment C_NIAMS OE Day Survey QR Code.docx	09/13/2023

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