Information Collection

Provider Feedback for Chlamydia Prevention and Control Online Resources

IC 214752 under ICR 201407-0920-003 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Provider Feedback for Chlamydia Prevention and Control Online Resources	Form and Instruction
Att2 CaseStudyResourceReview.docx	Instruction
Recruitment screener Att1 RecruitmentScreener.docx	Form and Instruction
Moderator's guide Att3 ModeratorGuide.docx	Form and Instruction
Generic Clearance for Qualitative Feedback Template Approval Form Screener.docx Request for Approval - screener	IC Document
Generic Clearance for Qualitative Feedback Template Approval Form.docx Request for approval - moderator's guide	IC Document
NCC_RecruitingTalkingPoints.docx Talking points for recruitment	IC Document
Supporting Statements.docx Supporting Statements	IC Document
EmailContent to Participants.docx Email	IC Document
Recruitment announcement.docx Recruitment flyer	IC Document

IC Title:

Provider Feedback for Chlamydia Prevention and Control Online Resources

Agency IC Tracking Number:

15GA

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Recruitment screener	Att1 RecruitmentScreener.docx	Yes	No	Fillable Printable
Instruction			Att2 CaseStudyResourceReview.docx	Yes	No	Fillable Printable
Form and Instruction	none	Moderator's guide	Att3 ModeratorGuide.docx	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	37	37
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval - screener	Generic Clearance for Qualitative Feedback Template Approval Form Screener.docx	01/26/2015
Request for approval - moderator's guide	Generic Clearance for Qualitative Feedback Template Approval Form.docx	01/26/2015
Talking points for recruitment	NCC_RecruitingTalkingPoints.docx	01/26/2015
Supporting Statements	Supporting Statements.docx	01/26/2015
Email	EmailContent to Participants.docx	01/26/2015
Recruitment flyer	Recruitment announcement.docx	01/26/2015

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