Information Collection

Solve the Outbreak (14GM)

IC 210038 under ICR 201303-0920-011 · OMB 0920-0956.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0956 can be found here:

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Solve the Outbreak (14GM)

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	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 %

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	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

table that charts IC Documents
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.