Information Collection

Web-based Survey to Improve the Quality and Effectiveness of CDC's Technical Assistance and Resources Promoting Adoption of IOM Hypertension Recommendations for States

IC 200854 under ICR 201008-0920-003 · OMB 0920-0864.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Web-based Survey to Improve the Quality and Effectiveness of CDC's Technical Assistance and Resources Promoting Adoption of IOM Hypertension Recommendations for States	Form
Survey to Assess Adoption and Use of IOM Report on Hyper IC_6_Att_1a_Survey_draft.doc	Form
IC_6_Att_1b_Survey_screenshots.PDF Screenshots of Survey	IC Document
IC_6_Supporting Statement_Part A_1 13 2012.docx Supporting Statement A	IC Document
IC_6_Supporting Statement_Part B_1 13 2012.docx Supporting Statement B	IC Document
IC_6_Att_2_Introductory_Email_11_16_11.docx Att 2 - Intro email	IC Document
IC_6_Att_3_Invitation_to_participate_email_11_16_11.docx Att 3 - Invite email	IC Document
IC_6_Att_4_Follow_up_reminder_email_11_16_11.docx Att 4 - Reminder email	IC Document
IC_6_Att_5_Thank You E-mail_11_16_11.docx Att 5 - Thank you email	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Web-based Survey to Improve the Quality and Effectiveness of CDC's Technical Assistance and Resources Promoting Adoption of IOM Hypertension Recommendations for States

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Survey to Assess Adoption and Use of IOM Report on Hypertension	IC_6_Att_1a_Survey_draft.doc		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	51	0	0	0	0	0
Annual IC Time Burden (Hours)	21	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screenshots of Survey	IC_6_Att_1b_Survey_screenshots.PDF	01/19/2012
Supporting Statement A	IC_6_Supporting Statement_Part A_1 13 2012.docx	01/19/2012
Supporting Statement B	IC_6_Supporting Statement_Part B_1 13 2012.docx	01/19/2012
Att 2 - Intro email	IC_6_Att_2_Introductory_Email_11_16_11.docx	01/19/2012
Att 3 - Invite email	IC_6_Att_3_Invitation_to_participate_email_11_16_11.docx	01/19/2012
Att 4 - Reminder email	IC_6_Att_4_Follow_up_reminder_email_11_16_11.docx	01/19/2012
Att 5 - Thank you email	IC_6_Att_5_Thank You E-mail_11_16_11.docx	01/19/2012

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