EDN User Assessment

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Document Name Document Type
EDN User Assessment Form
EDN User Survey - screenshots Att 1 - Final Survey Screenshots.docx Form
EDN User Survey - word EDN User Assessment_finalsurvey.pdf Form
Service Delivery Fast Track Template_EDNUserAssessment_12.5.docx Request for Approval IC Document
Att 2 - Email notifications.docx Email notifications IC Document
Att 3 - Non-researech determination.pdf Non-research determination IC Document

Information Collection (IC) Details

IC Title:	EDN User Assessment	Agency IC Tracking Number:	0920-1071-18IF

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	EDN User Survey - screenshots	Att 1 - Final Survey Screenshots.docx		Yes	Yes	Fillable Fileable
Form	none	EDN User Survey - word	EDN User Assessment_finalsurvey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,003	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	1,003	1,003
Annual IC Time Burden (Hours)	251	251
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Service Delivery Fast Track Template_EDNUserAssessment_12.5.docx	12/06/2017
Email notifications	Att 2 - Email notifications.docx	12/06/2017
Non-research determination	Att 3 - Non-researech determination.pdf	12/06/2017

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