CPHP Customer/Partner Follow-up Interview Instrument

Centers for Public Health Preparedness Program Evaluation

Documents and Forms

Document Name Document Type
CPHP Customer/Partner Follow-up Interview Instrument Form
Customer/Partner Follow-up Survery Instrument Attachment E_Customer-Partner Follow-Up Interview Instrument.CDC FINAL.doc Form
Attachment G_E-mail follow-up.doc Email Follow-up to Customer/Partner Survey IC Document
Attachment H_Telephone follow-up.doc Telephone Follow-up to Customer Survey IC Document

Information Collection (IC) Details

IC Title:	CPHP Customer/Partner Follow-up Interview Instrument	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	none	Customer/Partner Follow-up Survery Instrument	Attachment E_Customer-Partner Follow-Up Interview Instrument.CDC FINAL.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email Follow-up to Customer/Partner Survey	Attachment G_E-mail follow-up.doc	07/13/2009
Telephone Follow-up to Customer Survey	Attachment H_Telephone follow-up.doc	07/13/2009

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