2012 Healthy New Year Video Contest Submission Form

2012 Healthy New Year Video Contest

Documents and Forms

Document Name Document Type
0990-Emergency_2012 Healthy New Year Video Challenge_Contest_Submission Form__010811[1].doc Other-instrument
0990-Healthy New Year Challenge_OMB01092012_Emergency Justification Letter[1].doc Emergency Justification letter IC Document

Information Collection (IC) Details

IC Title:	2012 Healthy New Year Video Contest Submission Form	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-instrument			0990-Emergency_2012 Healthy New Year Video Challenge_Contest_Submission Form__010811[1].doc		No	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Emergency Justification letter	0990-Healthy New Year Challenge_OMB01092012_Emergency Justification Letter[1].doc	01/10/2012

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