Information Collection

Main Survey

IC 202023 under ICR 201309-0955-001 · OMB 0955-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990- ONC-ConsumerSurvey.docx	Other-survey
ONCConsumerPrivacySurveyFinal05-02-2012.docx	Other-Consumer Privacy Survey
ONCConsumerPrivacySurveyFinalSpanish.docx	Other-consumer Privacy Surevey Spani
0990-ONCConsumerPrivacySurvey Questionnaire Final6 19.docx	Other-ONCConsumerPrivacySurvey Quest
0990-ONCcunsumerBriefing Slides Cognitive Interviews_022912.pptx	Other-ConsumerBriefing Slides Cognit
HHS ONC Questionnaire FinalMain_080112.docx	Other-Survey form - English
Spanish HHS ONC Questionnaire FinalMain_080112.docx	Other-Survey form - Spanish
HHS ONC Survey Introduction and Consent Script_NORC 080112.docx Survey script - English	IC Document
Spanish HHS ONC Survey Introduction and Consent Script_NORC 080112.docx Survey script - Spanish	IC Document

IC Title:

Main Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey	0990- ONC-ConsumerSurvey.docx	Yes	Yes	Printable Only
Other-Consumer Privacy Survey	ONCConsumerPrivacySurveyFinal05-02-2012.docx	Yes	Yes	Printable Only
Other-consumer Privacy Surevey Spanish	ONCConsumerPrivacySurveyFinalSpanish.docx	Yes	Yes	Printable Only
Other-ONCConsumerPrivacySurvey Questionnaire Final6 19	0990-ONCConsumerPrivacySurvey Questionnaire Final6 19.docx	Yes	No	Printable Only
Other-ConsumerBriefing Slides Cognitive Interviews_022912	0990-ONCcunsumerBriefing Slides Cognitive Interviews_022912.pptx	Yes	No	Printable Only
Other-Survey form - English	HHS ONC Questionnaire FinalMain_080112.docx	Yes	Yes	Fillable Fileable
Other-Survey form - Spanish	Spanish HHS ONC Questionnaire FinalMain_080112.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey script - English	HHS ONC Survey Introduction and Consent Script_NORC 080112.docx	08/08/2012
Survey script - Spanish	Spanish HHS ONC Survey Introduction and Consent Script_NORC 080112.docx	08/08/2012

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