Epi-Aid Satisfaction and Impact Assessment

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.