Appendix_A_RUDI_Provider_Subrecipient_Survey

Rapid Uptake of Disseminated Interventions (RUDI) Evaluation

Documents and Forms

Document Name Document Type
Form 1 Appendix_A_RUDI_Provider_Subrecipient_Survey Form and Instruction
1 RUDI - Provider Survey Appendix_A_RUDI_Provider_Subrecipient_Survey.docx Form and Instruction
1 RUDI - Provider Survey Appendix_A_RUDI_Provider_Subrecipient_Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Appendix_A_RUDI_Provider_Subrecipient_Survey	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	1	RUDI - Provider Survey	Appendix_A_RUDI_Provider_Subrecipient_Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,066	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,066	1,066
Annual IC Time Burden (Hours)	352	352
Annual IC Cost Burden (Dollars)	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.