Information Collection

CDC Influenza Partner Activity Web Page Evaluation

IC 217790 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A_Influenza Partner Activity Webpage Evaluation_Protocol, Email blurb and survey instrument.docx	Other-WORD
Attachment B_CDC Influenza Partner Activity Web Page Evaluation Screenshots_Surveymonkey.docx	Other-Screenshots
0920-1026 GenIC Submission_ CDC Influenza Partner Activity Web Page Evaluation_Final.docx Request for Approval	IC Document

IC Title:

Agency IC Tracking Number:

15AZL

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			Attachment A_Influenza Partner Activity Webpage Evaluation_Protocol, Email blurb and survey instrument.docx		Yes	Yes	Fillable Printable
Other-Screenshots			Attachment B_CDC Influenza Partner Activity Web Page Evaluation Screenshots_Surveymonkey.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,096

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	1,096	1,096
Annual IC Time Burden (Hours)	274	274
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	0920-1026 GenIC Submission_ CDC Influenza Partner Activity Web Page Evaluation_Final.docx	08/05/2015

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