Information Collection

CDC Spanish Homepage Survey

IC 212251 under ICR 201402-0920-015 · OMB 0920-0956.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CDC Spanish Homepage Survey	Form
Spanish Homepage Survey Appendix C -Spanish Homepage Survey Screen shots.docx	Form
English Homepage Survey Appendix D-English Homepage Survey Screen shots.docx	Form
fast-track-PRA-submission-short-form-CDC Spanish Homepage Survey.docx Request for Approval	IC Document
Appendix A-Pop-up Box.docx Pop-up Box	IC Document
CDC Spanish Homepage Survey Protocol.docx Protocol for Survey	IC Document
Appendix B-Spanish Homepage Survey Questions.docx Survey Questions - word	IC Document

IC Title:

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	Spanish Homepage Survey	Appendix C -Spanish Homepage Survey Screen shots.docx		Yes	Yes	Fillable Fileable
Form	none	English Homepage Survey	Appendix D-English Homepage Survey Screen shots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	fast-track-PRA-submission-short-form-CDC Spanish Homepage Survey.docx	07/07/2014
Pop-up Box	Appendix A-Pop-up Box.docx	07/07/2014
Protocol for Survey	CDC Spanish Homepage Survey Protocol.docx	07/07/2014
Survey Questions - word	Appendix B-Spanish Homepage Survey Questions.docx	07/07/2014

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