Solve the Outbreak Mobile App Survey

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

Documents and Forms

Document Name Document Type
SURVEY_Solve the Outbreak.docx Other-WORD
SCREENSHOTS_Solve the Outbreak.docx Screenshots IC Document
OMB _SolvetheOutbreak.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Solve the Outbreak Mobile App Survey	Agency IC Tracking Number:	14ANX

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
Other-WORD			SURVEY_Solve the Outbreak.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Screenshots	SCREENSHOTS_Solve the Outbreak.docx	07/10/2014
Request for Approval	OMB _SolvetheOutbreak.docx	07/10/2014

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