Core VIPP Funded State Health Department--State of the States Survey

Evaluation of Core Violence and Injury Prevention Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0916 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Core VIPP Funded State Health Department--State of the States Survey Form and Instruction
1 State of the States Survey in PDF format Attachment C-1 - PDF.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Core VIPP Funded State Health Department--State of the States Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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	1	State of the States Survey in PDF format	Attachment C-1 - PDF.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Previously Approved
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	84	84
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.