Document Name Document Type
CPPW Resource Center Feedback Assessment and IMATS Assessment Form
CPPW Web Survey Attachment D_CPPW Data Collection Instrument (Online).docx Form
IMATS Web Survey Attachment F IMATS Data Collection Instrument-Web Version.docx Form
Attachment E_CPPW Initial Email with Instructions.docx CPPW Initial Email with Instructions IC Document
Attachment C_CPPW Data Collection Instrument (Word).docx CPPW Survey Word Version IC Document
Attachment F_CPPW Reminder email.docx CPPW Reminder Email IC Document
Attachment G_CPPW Final Reminder email.docx CPPW Final Email IC Document
Attachment A_CPPW Online Resource Center Screen Shots.docx CPPW Resource Center Screen Shots IC Document
Attachment B_CPPW Resource Center Guide.pdf CPPW Resource Center Guide IC Document
CPPW_Supporting Statement A.docx CPPW Supporting Statement Part A IC Document
CPPW_Supporting Statement B.docx CPPW Supporting Statement Part B IC Document
Attachment G IMATS Data Collection Instrument-Word Version.docx IMATS Survey Word Version IC Document
Attachment H IMATS Introductory Email.docx IMATS Introductory Email IC Document
Attachment I IMATS Reminder Email.docx IMATS Reminder Email IC Document
Attachment J IMATS Followup Email.docx IMATS Followup Email IC Document
Attachment A CTS Brochure.pdf CTS Brochure IC Document
Attachment B CTS Poster.pdf CTS Poster IC Document
Attachment C IMATS Agile Methodolody.docx IMATS - Argile Methodology IC Document
Attachment D IMATS Application Screenshots.docx IMATS - Application Screenshots IC Document
Attachment E IMATS Implementation Map.docx IMATS - Implementation Map IC Document
IMATS Supporting Statement Part B.docx IMATS Supporting Statement Part B IC Document
IMATS Supporting Statement Part A.docx IMATS Supporting Statement Part A IC Document

Information Collection (IC) Details

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IC Title:	CPPW Resource Center Feedback Assessment and IMATS Assessment	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	CPPW Web Survey	Attachment D_CPPW Data Collection Instrument (Online).docx		Yes	Yes	Fillable Fileable
Form	none	IMATS Web Survey	Attachment F IMATS Data Collection Instrument-Web Version.docx		Yes	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 414	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	414	0	0	0	0	0
Annual IC Time Burden (Hours)	138	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
CPPW Initial Email with Instructions	Attachment E_CPPW Initial Email with Instructions.docx	07/30/2012
CPPW Survey Word Version	Attachment C_CPPW Data Collection Instrument (Word).docx	07/30/2012
CPPW Reminder Email	Attachment F_CPPW Reminder email.docx	07/30/2012
CPPW Final Email	Attachment G_CPPW Final Reminder email.docx	07/30/2012
CPPW Resource Center Screen Shots	Attachment A_CPPW Online Resource Center Screen Shots.docx	07/30/2012
CPPW Resource Center Guide	Attachment B_CPPW Resource Center Guide.pdf	07/30/2012
CPPW Supporting Statement Part A	CPPW_Supporting Statement A.docx	07/30/2012
CPPW Supporting Statement Part B	CPPW_Supporting Statement B.docx	07/30/2012
IMATS Survey Word Version	Attachment G IMATS Data Collection Instrument-Word Version.docx	07/30/2012
IMATS Introductory Email	Attachment H IMATS Introductory Email.docx	07/30/2012
IMATS Reminder Email	Attachment I IMATS Reminder Email.docx	07/30/2012
IMATS Followup Email	Attachment J IMATS Followup Email.docx	07/30/2012
CTS Brochure	Attachment A CTS Brochure.pdf	07/30/2012
CTS Poster	Attachment B CTS Poster.pdf	07/30/2012
IMATS - Argile Methodology	Attachment C IMATS Agile Methodolody.docx	07/30/2012
IMATS - Application Screenshots	Attachment D IMATS Application Screenshots.docx	07/30/2012
IMATS - Implementation Map	Attachment E IMATS Implementation Map.docx	07/30/2012
IMATS Supporting Statement Part B	IMATS Supporting Statement Part B.docx	07/31/2012
IMATS Supporting Statement Part A	IMATS Supporting Statement Part A.docx	07/31/2012

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

CPPW Resource Center Feedback Assessment and IMATS Assessment

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

OMB: 0920-0879

IC ID: 203549

View Information Collection (IC)