Information Collection

TB Laboratory Site Visit Evaluation Six-Month Follow-Up-Online Survey

IC 226173 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⚠️ Notice: This information collection may be referencing outdated material.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
TB Laboratory Site Visit Evaluation Six-Month Follow-Up-Online Survey	Form
Appendix 1_Survey Questions_Site Visit Evaluation_ Six m Appendix 1_Survey Questions_Site Visit Evaluation_ Six month Follow-up.docx	Form
Appendix 2_Web Shots_Survey Questions_Site Visit Evaluat Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation_Six Month Follow-up.docx	Form
Template-Customer Feedback_ TB Site Visit_Online.docx Template-Customer Feedback_ TB Site Visit_Online	IC Document
Appendix 3_Web Shot_Reminder email.docx Appendix 3_Web Shot_Reminder email	IC Document

IC Title:

TB Laboratory Site Visit Evaluation Six-Month Follow-Up-Online Survey

Agency IC Tracking Number:

17AAM

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	N/A	Appendix 1_Survey Questions_Site Visit Evaluation_ Six month Follow-up	Appendix 1_Survey Questions_Site Visit Evaluation_ Six month Follow-up.docx		Yes	Yes	Fillable Fileable
Form	N/A	Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation_Six Month Follow-up	Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation_Six Month Follow-up.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 58

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	58	58
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template-Customer Feedback_ TB Site Visit_Online	Template-Customer Feedback_ TB Site Visit_Online.docx	03/23/2017
Appendix 3_Web Shot_Reminder email	Appendix 3_Web Shot_Reminder email.docx	03/23/2017

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