Solve the Outbreak (14GM)

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0956 can be found here:

Documents and Forms

Document Name Document Type
Solve the Outbreak (14GM) Form
F-MobileAppScreenshots - CDC_STOapplication__UX_01_07_2014 - OMB.pdf Other-Screenshots
Questionnaire D-Questionnaire -CDC_STOapplication_UX_01_07_2014 - OMB.docx Form
fast-track-PRA-submission-short-form-cdc_Solve the Outbreak iPad Usability Protocol_01_07_2014.docx fast-track-PRA-submission-short-form-cdc_Solve the Outbreak iPad Usability Protocol_01_07_2014 IC Document
A-Protocal -CDC_STOapplication_UX_01_07_2014 - OMB.docx A-Protocal -CDC_STOapplication_UX_01_07_2014 - OMB IC Document
B-Instructions -CDC_STOapplication_UX_01_07_2014 - OMB.docx B-Instructions -CDC_STOapplication_UX_01_07_2014 - OMB IC Document
C-Consent Forms -CDC_STOapplication_UX_01_07_2014 - OMB.docx C-Consent Forms -CDC_STOapplication_UX_01_07_2014 - OMB IC Document
E-Scenarios -CDC_STOapplication_UX_01_07_2014 - OMB.docx E-Scenarios -CDC_STOapplication_UX_01_07_2014 - OMB IC Document

Information Collection (IC) Details

IC Title:	Solve the Outbreak (14GM)	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	Questionnaire	D-Questionnaire -CDC_STOapplication_UX_01_07_2014 - OMB.docx		Yes	No	Printable Only
Other-Screenshots			F-MobileAppScreenshots - CDC_STOapplication__UX_01_07_2014 - OMB.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	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	100	0	0	0	0	0
Annual IC Time Burden (Hours)	50	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
fast-track-PRA-submission-short-form-cdc_Solve the Outbreak iPad Usability Protocol_01_07_2014	fast-track-PRA-submission-short-form-cdc_Solve the Outbreak iPad Usability Protocol_01_07_2014.docx	01/10/2014
A-Protocal -CDC_STOapplication_UX_01_07_2014 - OMB	A-Protocal -CDC_STOapplication_UX_01_07_2014 - OMB.docx	01/10/2014
B-Instructions -CDC_STOapplication_UX_01_07_2014 - OMB	B-Instructions -CDC_STOapplication_UX_01_07_2014 - OMB.docx	01/10/2014
C-Consent Forms -CDC_STOapplication_UX_01_07_2014 - OMB	C-Consent Forms -CDC_STOapplication_UX_01_07_2014 - OMB.docx	01/10/2014
E-Scenarios -CDC_STOapplication_UX_01_07_2014 - OMB	E-Scenarios -CDC_STOapplication_UX_01_07_2014 - OMB.docx	01/10/2014

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