Program Partners

Use of Evidence Based Practices for Comprehensive Cancer Control

Documents and Forms

Document Name Document Type
Program Partners Form and Instruction
Web Survey Attachment D1. Program Partners Web Survey_rev 1 18 2012.docx Form and Instruction
Attachment D2. Program Partners Invitation Email.docx Att D2 - Invitation email IC Document
Attachment D3. Program Partners Follow Up Email.docx Att D3 - Follow-up Email IC Document
Attachment D4. Program Partners Postcard.docx Att D4 - Postcard reminder IC Document
Attachment D5. Program Partners Thank You Email.docx Att D5 - Thank you Email IC Document

Information Collection (IC) Details

IC Title:	Program Partners	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	none	Web Survey	Attachment D1. Program Partners Web Survey_rev 1 18 2012.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 132	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	132	132
Annual IC Time Burden (Hours)	66	66
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att D2 - Invitation email	Attachment D2. Program Partners Invitation Email.docx	10/31/2011
Att D3 - Follow-up Email	Attachment D3. Program Partners Follow Up Email.docx	10/31/2011
Att D4 - Postcard reminder	Attachment D4. Program Partners Postcard.docx	10/31/2011
Att D5 - Thank you Email	Attachment D5. Program Partners Thank You Email.docx	10/31/2011

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