Solve the Outbreak iPad Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

OMB: 0920-0956

IC ID: 207575

Information Collection (IC) Details

View Information Collection (IC)

Solve the Outbreak iPad Survey
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Survey STO_screenshots.docx Yes Yes Fillable Fileable

Health Health Care Services

 

5,000 0
   
Individuals or Households
 
   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 5,000 0 0 0 0 0
Annual IC Time Burden (Hours) 417 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval Surveytemplate _SolvetheOutbreak.docx 06/26/2013
Survey - Word version Solve the Outbreak User Zoom Questions.docx 06/26/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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