Information Collection

Solve the Outbreak Mobile App Survey

IC 212305 under ICR 201402-0920-015 · OMB 0920-0956.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

14ANX

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.