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2015 Immunization Awardee Meeting Evaluation
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCIRD)
OMB: 0920-1026
IC ID: 217768
OMB.report
HHS/CDC
OMB 0920-1026
ICR 201407-0920-001
IC 217768
( )
Documents and Forms
Document Name
Document Type
2015 Immunization Awardee Meeting Evaluation
Form
Evaluation Survey
Attachment 2_2015 Immunization Awardee Meeting Evaluation_Survey_Screenshots.pdf
Form
Attachment 1_2015 Immunization Awardee Meeting IAM Evaluation_Survey.docx
Survey - Word Doc
IC Document
Attachment 3_ 2015 Immunization Awardee Meeting_Invite email.docx
Email Invite
IC Document
Attachment 4_2015 Immunization Awardee Meeting _Reminder Email.docx
Email Reminder
IC Document
GenIC 0920-1026_2015 Immunization Awardee Meeting Evaluation.docx
Request for Approval
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
2015 Immunization Awardee Meeting Evaluation
Agency IC Tracking Number:
15BBH
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
Evaluation Survey
Attachment 2_2015 Immunization Awardee Meeting Evaluation_Survey_Screenshots.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
242
Number of Respondents for Small Entity:
10
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
242
0
242
0
0
0
Annual IC Time Burden (Hours)
32
0
32
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Survey - Word Doc
Attachment 1_2015 Immunization Awardee Meeting IAM Evaluation_Survey.docx
08/04/2015
Email Invite
Attachment 3_ 2015 Immunization Awardee Meeting_Invite email.docx
08/04/2015
Email Reminder
Attachment 4_2015 Immunization Awardee Meeting _Reminder Email.docx
08/04/2015
Request for Approval
GenIC 0920-1026_2015 Immunization Awardee Meeting Evaluation.docx
08/04/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.