View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	[OADC] DSMES Playbook Survey at ADCES Exhibit Hall	Agency IC Tracking Number:	0920-0572-24HZ

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
Other-WORD version			ADCES SurveyInstrument060524.docx		No		Printable Only
Form	0920-0572	ADCES Exhibit Hall Playbook Survey	ADCES SurveyScreenshots060524.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

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)	7	0	7	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
(HMTS)_Expedited Review Form "DSMES Playbook Survey at ADCES Exhibit Hall'	HMTSformADCESExhibit060524.docx	08/07/2024
Supplement to the HMTS Expedited Review Form	PlaybookSuppforHTMSform060524.docx	08/07/2024
IRB Determination	IRBNonResDetermination060524.pdf	08/07/2024

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