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MUH Operator Post-intervention Survey - LA county
Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies
OMB: 0920-1004
IC ID: 204440
OMB.report
HHS/CDC
OMB 0920-1004
ICR 201309-0920-011
IC 204440
( )
Documents and Forms
Document Name
Document Type
MUH Operator Post-intervention Survey - LA county
Form
7A - MUH operator post-intervention survey - LA county
clean 12.17.16 Att 7A(e)_Post-Intervention Operator Survey.doc
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MUH Operator Post-intervention Survey - LA county
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
none
7A - MUH operator post-intervention survey - LA county
clean 12.17.16 Att 7A(e)_Post-Intervention Operator Survey.doc
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
130
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
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
130
0
130
0
0
0
Annual IC Time Burden (Hours)
163
0
163
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.