Pilot Messaging Campaign Follow-up 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0919 can be found here:

Documents and Forms

Document Name Document Type
Pilot Messaging Campaign Follow-up Survey Form
Customer Satisfaction Survey-Pilot Messaging Campaign Fo Att 1_Flu video survey screenshot.pptx Form
GenIC Clearance Submission - Video Messaging_rev.docx GenIC Clearance Submission - Video Messaging_rev IC Document
Supp_1 Video Screen Shots of CDC Flu Shots fo Children with Special Needs.pptx Supp_1 Video Screen Shots of CDC Flu Shots fo Children with Special Needs IC Document

Information Collection (IC) Details

IC Title:	Pilot Messaging Campaign Follow-up 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	Customer Satisfaction Survey-Pilot Messaging Campaign Follow-up Survey	Att 1_Flu video survey screenshot.pptx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

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	65	0	0	0	0	0
Annual IC Time Burden (Hours)	5	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Clearance Submission - Video Messaging_rev	GenIC Clearance Submission - Video Messaging_rev.docx	09/24/2013
Supp_1 Video Screen Shots of CDC Flu Shots fo Children with Special Needs	Supp_1 Video Screen Shots of CDC Flu Shots fo Children with Special Needs.pptx	09/24/2013

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