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Web-based Survey of NCCCP Coalition Members and NCCCP Partners
Assessment of Technical Assistance and Training Approaches to Accelerate Comprehensive Cancer Control Outcomes
OMB: 0920-1193
IC ID: 242185
OMB.report
HHS/CDC
OMB 0920-1193
ICR 202004-0920-020
IC 242185
( )
Documents and Forms
Document Name
Document Type
Web-based Survey of NCCCP Coalition Members and NCCCP Partners
Form and Instruction
Att 5d. Web-based survey (Word Format).docx
Other-Word version of survey content
Web-based Survey (screenshots)
Att 5e. Web-based survey (screenshots).docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Web-based Survey of NCCCP Coalition Members and NCCCP Partners
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
n/a
Web-based Survey (screenshots)
Att 5e. Web-based survey (screenshots).docx
Yes
Yes
Fillable Fileable
Other-Word version of survey content to facilitate content review
Att 5d. Web-based survey (Word Format).docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
88
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
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
88
0
0
88
0
0
Annual IC Time Burden (Hours)
22
0
0
22
0
0
Annual IC Cost Burden (Dollars)
1,306
0
0
1,306
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.