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Institutional Awareness and Commitment Survey (Partner Organizations)
Institutional Awareness and Commitment to Ensuring Safe, Stable, and Nurturing Relationships and Environments for Children
OMB: 0920-1010
IC ID: 210318
OMB.report
HHS/CDC
OMB 0920-1010
ICR 201402-0920-005
IC 210318
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1010 can be found here:
2014-05-22 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Attachment D - Survey.docx
Other-WORD
Attachment C - Survey Screenshots.pdf
Attachment C - Survey Screenshots
IC Document
Attachment E- Email Invitation.docx
Attachment E- Email Invitation
IC Document
Attachment F - Email Invitation Follow-up.docx
Attachment F - Email Invitation Follow-up
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Institutional Awareness and Commitment Survey (Partner Organizations)
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
Other-WORD
Attachment D - Survey.docx
Yes
Yes
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:
75
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 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
75
0
75
0
0
0
Annual IC Time Burden (Hours)
35
0
35
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment C - Survey Screenshots
Attachment C - Survey Screenshots.pdf
02/06/2014
Attachment E- Email Invitation
Attachment E- Email Invitation.docx
02/06/2014
Attachment F - Email Invitation Follow-up
Attachment F - Email Invitation Follow-up.docx
02/06/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.