Provide Services for the Dissemination of CER to Patients and Providers to Increas Adoption- Gutcheck Website Usability Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Document Name Document Type
0990-0379Appendix B web usability survey 9Nov2011.docx Other-testing
0990-0379Appendix A Screen shots of Gutcheck website 9Nov2011.pdf 0990-0379Appendix A Screen shots of Gutcheck website 9Nov2011 IC Document
0990-Generic Clearance Submission_Provide servies for the Disseminationof CER survey supporting statement 9Nov2011.docx 0990-Generic Clearance Submission_Provide servies for the Disseminationof CER survey supporting statement 9Nov2011 IC Document

Information Collection (IC) Details

IC Title:	Provide Services for the Dissemination of CER to Patients and Providers to Increas Adoption- Gutcheck Website Usability 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
Other-testing			0990-0379Appendix B web usability survey 9Nov2011.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	4,750	0	0	0	0	0
Annual IC Time Burden (Hours)	238	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0990-0379Appendix A Screen shots of Gutcheck website 9Nov2011	0990-0379Appendix A Screen shots of Gutcheck website 9Nov2011.pdf	11/18/2011
0990-Generic Clearance Submission_Provide servies for the Disseminationof CER survey supporting statement 9Nov2011	0990-Generic Clearance Submission_Provide servies for the Disseminationof CER survey supporting statement 9Nov2011.docx	11/18/2011

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