CCC Program Director Web Survey Questionnaire

Experiences with the Implementation and Outcomes of Policy and Environmental Cancer Control Interventions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1016 can be found here:

Documents and Forms

Document Name Document Type
Form 0920- CCC Program Director Web Survey Questionnaire Form and Instruction
Att C1b_Program_Director_Survey_Screen_Shots_11_01_13.docx Instruction
0920- Att C1a _Program_Director_Web_Survey_10_29_13 Att C1a _Program_Director_Web_Survey_10_29_13.docx Form and Instruction
Att C4_ Program_Director_Reminder_E-Mail_10_29_13.docx Att C4_ Program_Director_Reminder_E-Mail IC Document
Att C3_Program_Director_Advance_E-Mail_10_29_13.docx Att C3_Program_Director_Advance_E-Mai IC Document
Att C2 _Program_Director_Advance_Letter_10_29_13.docx Att C2 _Program_Director_Advance_LetterAtt C2 _Program_Director_Advance_Letter IC Document
Att C5_ Program_Director_Thankyou_E-Mail_10_29_13.docx Att C5_ Program_Director_Thankyou_E-Mail IC Document

Information Collection (IC) Details

IC Title:	CCC Program Director Web Survey Questionnaire	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	0920-	Att C1a _Program_Director_Web_Survey_10_29_13	Att C1a _Program_Director_Web_Survey_10_29_13.docx		Yes	Yes	Fillable Fileable
Instruction			Att C1b_Program_Director_Survey_Screen_Shots_11_01_13.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 43	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 Agency Discretion
Annual Number of Responses for this IC	43	43
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att C4_ Program_Director_Reminder_E-Mail	Att C4_ Program_Director_Reminder_E-Mail_10_29_13.docx	02/11/2014
Att C3_Program_Director_Advance_E-Mai	Att C3_Program_Director_Advance_E-Mail_10_29_13.docx	02/11/2014
Att C2 _Program_Director_Advance_LetterAtt C2 _Program_Director_Advance_Letter	Att C2 _Program_Director_Advance_Letter_10_29_13.docx	02/11/2014
Att C5_ Program_Director_Thankyou_E-Mail	Att C5_ Program_Director_Thankyou_E-Mail_10_29_13.docx	02/11/2014

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