CDC Infectious Diseases Reference Laboratories Customer Satisfaction 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⚠️ Notice: This information collection may be referencing outdated material.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
CDC Infectious Diseases Reference Laboratories Customer Satisfaction Survey Form
CDC ID Reference Labs Customer Satisfaction Survey Reference Labs - Attachment B OMB Formatted CDC Customer Survey rev.1-27-12.docx Form
Reference Labs - Supporting Statement A v012712.docx Supporting Statement A IC Document
Reference Labs - Supporting Statement B v012712.docx Supporting Statement B IC Document
Reference Labs- Attachment A CMS Letter to Dr Turgeon 10-26-2010.pdf Att A - Intro letter IC Document
Reference Labs - Attachment D Email Invitation to Survey.docx Att D - Email to PHL Directors IC Document
Reference Labs- Attachment E APHL Notice.docx Att E - APHL Notice IC Document
Reference Labs- Attachment F Email Reminder.docx Att F - Reminder email IC Document
Reference Labs- Attachment G APHL Reminder.docx Att G - APHL Reminder IC Document
Reference Labs- Attachment C Survey Monkey Customer Satisfaction Survey rev. 1-27-12.mht Att C - Survey screenshots IC Document

Information Collection (IC) Details

IC Title:	CDC Infectious Diseases Reference Laboratories Customer Satisfaction 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	CDC ID Reference Labs Customer Satisfaction Survey	Reference Labs - Attachment B OMB Formatted CDC Customer Survey rev.1-27-12.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	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	55	0	0	0	0	0
Annual IC Time Burden (Hours)	9	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 A	Reference Labs - Supporting Statement A v012712.docx	02/01/2012
Supporting Statement B	Reference Labs - Supporting Statement B v012712.docx	02/01/2012
Att A - Intro letter	Reference Labs- Attachment A CMS Letter to Dr Turgeon 10-26-2010.pdf	02/01/2012
Att D - Email to PHL Directors	Reference Labs - Attachment D Email Invitation to Survey.docx	02/01/2012
Att E - APHL Notice	Reference Labs- Attachment E APHL Notice.docx	02/01/2012
Att F - Reminder email	Reference Labs- Attachment F Email Reminder.docx	02/01/2012
Att G - APHL Reminder	Reference Labs- Attachment G APHL Reminder.docx	02/01/2012
Att C - Survey screenshots	Reference Labs- Attachment C Survey Monkey Customer Satisfaction Survey rev. 1-27-12.mht	02/01/2012

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