Information Collection

Needs and Perceptions of Did You Know

IC 198805 under ICR 201102-0920-005 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Needs and Perceptions of Did You Know	Form
DYK_ATTACH-C_Web_Survey_2011-08-03.docx	Other-Screen Shots Web Survey
Consent & Survey DYK_ATTACH-B_Word_Survey_2011-08-036.docx	Form
DYK_Supporting_Statement_PART-A_2011-08-03.docx Supporting Statement A	IC Document
DYK_Supporting_Statement_PART-B_2011-08-03.docx Supporting Statement B	IC Document
DYK_ATTACH-D_Survey_Notification_Email_2011-08-03.docx Survey Notification Email	IC Document
DYK_ATTACH-E_Survey_Reminder_Email_2011-08-03.docx Survey Reminder Email	IC Document
DYK_ATTACH-A_DYK_Samples_2011-08-03.docx Samples	IC Document

IC Title:

Needs and Perceptions of Did You Know

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	Consent & Survey	DYK_ATTACH-B_Word_Survey_2011-08-036.docx		Yes	Yes	Fillable Fileable
Other-Screen Shots Web Survey			DYK_ATTACH-C_Web_Survey_2011-08-03.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	500	0	0	0	0	0
Annual IC Time Burden (Hours)	125	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
Supporting Statement A	DYK_Supporting_Statement_PART-A_2011-08-03.docx	08/04/2011
Supporting Statement B	DYK_Supporting_Statement_PART-B_2011-08-03.docx	08/04/2011
Survey Notification Email	DYK_ATTACH-D_Survey_Notification_Email_2011-08-03.docx	08/04/2011
Survey Reminder Email	DYK_ATTACH-E_Survey_Reminder_Email_2011-08-03.docx	08/04/2011
Samples	DYK_ATTACH-A_DYK_Samples_2011-08-03.docx	08/04/2011

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