Information Collection

CDC Digital Health Tools Evaluation

IC 213571 under ICR 201402-0920-015 · OMB 0920-0956.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CDC Digital Health Tools Evaluation	Form
CDC Digital Health Tools Survey Attachment C-CDC-Digital-Health-Tools-Survey-Question-Screen-Shots-2.docx	Form
CDC Digital Health Tools Survey - word Attachment B-CDC Digital Health Tools Survey Questions-2.docx	Form
Attachment A-CDC-Digital-Health-Tools-Protocol.docx Survey Protocol	IC Document
fast-track-PRA-submission-short-form-cdc-DigitalHealthTools2014.docx Request for Approval	IC Document
Attachment D-CDC Digital Health Tools Screen Shots-2.docx Digital Health Tools -screenshots	IC Document

IC Title:

Agency IC Tracking Number:

15CH

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	CDC Digital Health Tools Survey	Attachment C-CDC-Digital-Health-Tools-Survey-Question-Screen-Shots-2.docx		Yes	Yes	Fillable Fileable
Form	none	CDC Digital Health Tools Survey - word	Attachment B-CDC Digital Health Tools Survey Questions-2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

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)	208	208
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey Protocol	Attachment A-CDC-Digital-Health-Tools-Protocol.docx	10/22/2014
Request for Approval	fast-track-PRA-submission-short-form-cdc-DigitalHealthTools2014.docx	10/22/2014
Digital Health Tools -screenshots	Attachment D-CDC Digital Health Tools Screen Shots-2.docx	10/22/2014

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