Solve the Outbreak (14GM)

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

Documents and Forms

Document Name Document Type
F-MobileAppScreenshots - CDC_STOapplication__UX_01_07_2014 - OMB.zip 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: 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
Other-Screenshots			F-MobileAppScreenshots - CDC_STOapplication__UX_01_07_2014 - OMB.zip		Yes	Yes	Fillable Fileable
Form	none	Questionnaire	D-Questionnaire -CDC_STOapplication_UX_01_07_2014 - OMB.docx		Yes	No	Printable Only

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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	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.