Radiation Dose Tool Feedback

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

OMB: 0923-0047

IC ID: 215833

Information Collection (IC) Details

View Information Collection (IC)

Radiation Dose Tool Feedback 15SN
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD ATT C RDT Public Screener.docx Yes Yes Fillable Printable
Other-WORD ATT D RDT PIO and Public Planners Screener.docx Yes Yes Fillable Printable
Other-WORD ATT F RDT Interview Guide for Public.docx Yes Yes Fillable Printable
Other-WORD ATT G RDT Interview Guide for Public Health.docx Yes Yes Fillable Printable

Health Public Health Monitoring

 

108 0
   
State, Local, and Tribal Governments
 
   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 108 0 108 0 0 0
Annual IC Time Burden (Hours) 48 0 48 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval Service Delivery GenIC Request Form_Radiation Dose Tool Feedback.pdf 03/24/2015
Att A: Protocol Summary ATT A RDT Protocol Summary.docx 03/24/2015
Att B_Protocol ATT B RDT Protocol.docx 03/24/2015
Att E: Participant Information Sheet ATT E Participant Info Sheet.docx 03/24/2015
Att H: Radiation Dose Tool Appendix H Radiation Dose Tool.pptx 03/24/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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