Core VIPP Non-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⚠️ Notice: This information collection may be referencing outdated material.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 2 Core VIPP Non-funded State Health Department State of the States Survey Form and Instruction
2 State of the States Survey in Word Format Attachment C-2 - WORD.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Core VIPP Non-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	2	State of the States Survey in Word Format	Attachment C-2 - WORD.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	22	22
Annual IC Time Burden (Hours)	66	66
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.