CDC Spanish Homepage Survey

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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	CDC Spanish Homepage Survey	Agency IC Tracking Number:

IC Status: New

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	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 %

	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

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.