Information Collection

Pilot Messaging Campaign Follow-up Survey

IC 208813 under ICR 201112-0920-014 · OMB 0920-0919.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0919 can be found here:

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Pilot Messaging Campaign Follow-up Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.