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Adult Targeted Surveillance Survey - screener
Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs
OMB: 0920-0977
IC ID: 203638
OMB.report
HHS/CDC
OMB 0920-0977
ICR 201305-0920-002
IC 203638
( )
Documents and Forms
Document Name
Document Type
Adult Targeted Surveillance Survey - screener
Form
Adult Targeted Surveillance Survey - telephone screener
Att 7C_ATSS_PhoneInterview.docx
Form
Adult Targeted Surveillance Survey telephone screener- S
Att 7C-S_ATSS_PhoneInterview_SP.docx
Form
Att 7D_ATSS_ItemSources_2013_0718.pdf
Att 7D_ATSS_ItemSources_2013_0718
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Adult Targeted Surveillance Survey - screener
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Adult Targeted Surveillance Survey - telephone screener
Att 7C_ATSS_PhoneInterview.docx
Yes
Yes
Fillable Fileable
Form
none
Adult Targeted Surveillance Survey telephone screener- Spanish
Att 7C-S_ATSS_PhoneInterview_SP.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
Epidemiologic Studies and Surveillance of Disease Problems
FR Citation:
57 FR 62812
Number of Respondents:
13,749
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
13,749
0
13,749
0
0
0
Annual IC Time Burden (Hours)
458
0
458
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 7D_ATSS_ItemSources_2013_0718
Att 7D_ATSS_ItemSources_2013_0718.pdf
08/06/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.