View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	[ATSDR] VSP Feedback Survey	Agency IC Tracking Number:	0923-0047-25-0001

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	n/a	VSP Feedback Survey	VSP Feedback Survey_draft_12.17.2024.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

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	500	0	500	0	0	0
Annual IC Time Burden (Hours)	83	0	83	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Template	ATSDR 0923-0047 GenlC Request Form_VSP Feedback Survey.docx	01/17/2025
Email	VSP Feedback Survey_email draft.docx	01/17/2025
OMB Control Header and Burden Statement	OMB Control Header and Burden Statement.docx	01/17/2025

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