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AFIX Quarterly Call Evaluation
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCIRD)
OMB: 0920-1026
IC ID: 218144
OMB.report
HHS/CDC
OMB 0920-1026
ICR 201407-0920-001
IC 218144
( )
Documents and Forms
Document Name
Document Type
Attachment 1_ AFIX Quarterly Call Evaluation Survey_Screenshots.pdf
Other-Screenshots
GenIC 0920-1026 AFIX Quarterly Call Evaluation.docx
Request for Approval
IC Document
Attachment 2_ AFIX Quarterly Call Evaluation Survey_Participation Email.docx
Att 2_ AFIX Quarterly Call_Participants Participation Email
IC Document
Attachment 3_ AFIX Quarterly Call Evaluation Survey_Reminder Email.docx
Att 3_AFIX Quarterly Call_Participants Follow-up Email
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
AFIX Quarterly Call Evaluation
Agency IC Tracking Number:
15BFB
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
30 CFR 42
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Screenshots
Attachment 1_ AFIX Quarterly Call Evaluation Survey_Screenshots.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
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
100
0
100
0
0
0
Annual IC Time Burden (Hours)
13
0
13
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for Approval
GenIC 0920-1026 AFIX Quarterly Call Evaluation.docx
09/10/2015
Att 2_ AFIX Quarterly Call_Participants Participation Email
Attachment 2_ AFIX Quarterly Call Evaluation Survey_Participation Email.docx
09/10/2015
Att 3_AFIX Quarterly Call_Participants Follow-up Email
Attachment 3_ AFIX Quarterly Call Evaluation Survey_Reminder Email.docx
09/10/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.