Information Collection

Epi-Aid Satisfaction and Impact Assessment

IC 215976 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Epi-Aid Satisfaction and Impact Assessment	Form
Epi-Aid Satsifaction and Impact Assessment Att. D. Instrument_Web Version.docx	Form
Epi-Aid Satisfaction and Impact Assessment - word versio Att. C. Instrument_Word Version.docx	Form
EPIAID-SSA.docx Supporting Statement A	IC Document
EPIAID-SSB.docx Supporting Statement B	IC Document
Att. B. Domestic Epi-Aids.docx Domestic Epi-Aids	IC Document
Att. E. Notification Email.docx Notification Email	IC Document
Att. F. Reminder Email.docx Reminder Email	IC Document
Att A Epi-Aid Fact Sheet_revised.docx Epi_Aid Info Sheet	IC Document

IC Title:

Epi-Aid Satisfaction and Impact Assessment

Agency IC Tracking Number:

15ZK

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	none	Epi-Aid Satsifaction and Impact Assessment	Att. D. Instrument_Web Version.docx		Yes	Yes	Fillable Fileable
Form	none	Epi-Aid Satisfaction and Impact Assessment - word version	Att. C. Instrument_Word Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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	60	60
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
Supporting Statement A	EPIAID-SSA.docx	04/06/2015
Supporting Statement B	EPIAID-SSB.docx	04/06/2015
Domestic Epi-Aids	Att. B. Domestic Epi-Aids.docx	04/06/2015
Notification Email	Att. E. Notification Email.docx	04/06/2015
Reminder Email	Att. F. Reminder Email.docx	04/06/2015
Epi_Aid Info Sheet	Att A Epi-Aid Fact Sheet_revised.docx	04/08/2015

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