Survey of Health Official Perceptions and Use of the CDC Prevention Status Report (PSR Survey)

Surveys of State, Tribal, Local and Territorial (STLT) Governmental Health Agencies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Survey of Health Official Perceptions and Use of the CDC Prevention Status Report (PSR Survey) Form
Survey Instrument (word version) Attachment B - Survey Instrument_MS Word.docx Form
Survey instrument (web version) Attachment C - Survey Instrument_Web.docx Form
2-Supporting Statement B_FINAL.docx Supporting Statement B IC Document
1-Supporting Statement A_FINAL.docx Supporting Statement A IC Document
Attachment A - Authorizing Law.docx Att A - Authorizing Legislation IC Document
Attachment D - SAMPLE PSR.pdf Att D - Sample PSR IC Document
Attachment E - Advance Survey Notification Email.docx Att E - Advance email IC Document
Attachment F - Survey Notification Email.docx Att F - Survey Notification email IC Document
Attachment G - Reminders (Email and Telephone).docx Att G - Reminders IC Document

Information Collection (IC) Details

IC Title:	Survey of Health Official Perceptions and Use of the CDC Prevention Status Report (PSR Survey)	Agency IC Tracking Number:

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	Survey Instrument (word version)	Attachment B - Survey Instrument_MS Word.docx		No	No	Fillable Printable
Form	none	Survey instrument (web version)	Attachment C - Survey Instrument_Web.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

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 %

	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)	17	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement B	2-Supporting Statement B_FINAL.docx	06/29/2011
Supporting Statement A	1-Supporting Statement A_FINAL.docx	06/29/2011
Att A - Authorizing Legislation	Attachment A - Authorizing Law.docx	06/29/2011
Att D - Sample PSR	Attachment D - SAMPLE PSR.pdf	06/29/2011
Att E - Advance email	Attachment E - Advance Survey Notification Email.docx	06/29/2011
Att F - Survey Notification email	Attachment F - Survey Notification Email.docx	06/29/2011
Att G - Reminders	Attachment G - Reminders (Email and Telephone).docx	06/29/2011

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