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CBO Qualtrics Survey
National Hypertension Control Initiative
OMB: 0990-0482
IC ID: 252916
OMB.report
HHS/HHSDM
OMB 0990-0482
ICR 202301-0990-002
IC 252916
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0482 can be found here:
2024-04-10 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
CBO Qualtrics Survey
Form and Instruction
Form 1
CBO Qualtrics Survey
Form and Instruction
1 CBOs: Qualtrics survey
Appendix B_Qualtrics and DREaM CBO quarterly survey questions_Final.docx
Form and Instruction
1 CBOs: Qualtrics survey
Appendix B_Qualtrics and DREaM CBO quarterly survey questions_Final.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CBO Qualtrics Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
5 CFR 1320.8(d)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
1
CBOs: Qualtrics survey
Appendix B_Qualtrics and DREaM CBO quarterly survey questions_Final.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
National Hypertension Control Initiative - CBOs: Qualtrics survey
FR Citation:
86 FR 70510
Number of Respondents:
16
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
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
128
0
0
0
0
128
Annual IC Time Burden (Hours)
192
0
0
0
0
192
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.