Dissemination Update Form

Assessment of the Underage Drinking Prevention Education Initiatives State/Territory Videos Project

Documents and Forms

Document Name Document Type
Form Dissemination Upda Dissemination Update Form Form and Instruction
Dissemination Upda Dissemination Update Form Attachment 2_Dissemination Update Form_102611.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Dissemination Update Form	Agency IC Tracking Number:

Is this a Common Form? No		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	Dissemination Update Form	Dissemination Update Form	Attachment 2_Dissemination Update Form_102611.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	57	57
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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