Assessing the Utility of the Community Guide Website and Products Among STLT Email Subscribers

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⚠️ Notice: This information collection may be referencing outdated material.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
Assessing the Utility of the Community Guide Website and Products Among STLT Email Subscribers Form
CG Web Survey - Word Attach C. Community Guide Web Survey of STLT Email Subscribers Word Version.docx Form
CG Web Survey - screenshots Attach D Community Guide Web Survey of STLT Email Subscribers Web Version.pdf Form
Community Guide Assessment Supporting Statement A.docx Supporting Statement A IC Document
Community Guide Assessment Supporting Statement B.docx Supporting Statement B IC Document
Attach A. Screenshot of The Community Guide Website Homepage.docx Att A - Screenshot of CG Homepage IC Document
Attach B. Screenshot of Sample Task Force Recommendation for Birth Defects.docx Att B - Screenshot of CG Recommendation IC Document
Attach E. Email notification of Community Guide Web Survey of STLT Email Subscribers.docx Att E - Email Notification IC Document
Attach F. Email reminders days 7 14 20 to complete Community Guide Web Survey of STLT Email Subscribers.docx Att F - Email Reminder IC Document

Information Collection (IC) Details

IC Title:	Assessing the Utility of the Community Guide Website and Products Among STLT Email Subscribers	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	CG Web Survey - Word	Attach C. Community Guide Web Survey of STLT Email Subscribers Word Version.docx		Yes	Yes	Fillable Fileable
Form	none	CG Web Survey - screenshots	Attach D Community Guide Web Survey of STLT Email Subscribers Web Version.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,326	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	2,326	0	0	0	0	0
Annual IC Time Burden (Hours)	310	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	Community Guide Assessment Supporting Statement A.docx	01/07/2013
Supporting Statement B	Community Guide Assessment Supporting Statement B.docx	01/07/2013
Att A - Screenshot of CG Homepage	Attach A. Screenshot of The Community Guide Website Homepage.docx	01/07/2013
Att B - Screenshot of CG Recommendation	Attach B. Screenshot of Sample Task Force Recommendation for Birth Defects.docx	01/07/2013
Att E - Email Notification	Attach E. Email notification of Community Guide Web Survey of STLT Email Subscribers.docx	01/07/2013
Att F - Email Reminder	Attach F. Email reminders days 7 14 20 to complete Community Guide Web Survey of STLT Email Subscribers.docx	01/07/2013

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