View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	[CGH] Shiriki Virtual Community Annual Planning Survey	Agency IC Tracking Number:	0920-1050-24CJ

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	Shiriki Protocol New Member_Webinar Feedback Form	Protocol_Shiriki community_Nov 2023.docx	N/A	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: 200	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)	17	0	17	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0920-1050 GenIC Request Template	0920-1050_Shiriki annual community annual survey.docx	01/24/2024

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