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Learn the Signs. Act Early. Partner Webinars
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0920-0919
IC ID: 214699
OMB.report
HHS/CDC
OMB 0920-0919
ICR 201410-0920-001
IC 214699
( )
Documents and Forms
Document Name
Document Type
Learn the Signs. Act Early. Partner Webinars
Form
Iniital survey
Att1 InitialSurvey Edited Dec 2 2014 - DG+CP.docx
Form
Initial survey - screenshots
Att1a Screenshots-Initial 12-3-14.docx
Form
Follow-up survey
Att2 FollowUpSurvey Edited Nov 12 2014 - DG+CP.docx
Form
Follow-up survey - screenshots
Att2a Screenshots-Follow up 12-3-14.docx
Form
OMB LTSAE Webinar DRAFT SUBMISSION Rev Dec 2 2014 DG+CP.docx
Request for Approval
IC Document
Att3.RecruitmentEmail.docx
Recruitment emails
IC Document
Att4.LTSAE Webinar Powerpoint Slides.pptx
Webinar materials
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Learn the Signs. Act Early. Partner Webinars
Agency IC Tracking Number:
15GF
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
Iniital survey
Att1 InitialSurvey Edited Dec 2 2014 - DG+CP.docx
Yes
Yes
Fillable Fileable
Form
none
Initial survey - screenshots
Att1a Screenshots-Initial 12-3-14.docx
Yes
Yes
Fillable Fileable
Form
none
Follow-up survey
Att2 FollowUpSurvey Edited Nov 12 2014 - DG+CP.docx
Yes
Yes
Fillable Fileable
Form
none
Follow-up survey - screenshots
Att2a Screenshots-Follow up 12-3-14.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
1,200
0
1,200
0
0
0
Annual IC Time Burden (Hours)
40
0
40
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for Approval
OMB LTSAE Webinar DRAFT SUBMISSION Rev Dec 2 2014 DG+CP.docx
01/21/2015
Recruitment emails
Att3.RecruitmentEmail.docx
01/21/2015
Webinar materials
Att4.LTSAE Webinar Powerpoint Slides.pptx
01/21/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.