CDC-INFO Email Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
CDC-INFO Email Survey Form
CDC-INFO Email Survey CDC-INFO Email Survey_2016.docx Form
Generic Clearance Submission Template_2016_Email Survey.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	CDC-INFO Email Survey	Agency IC Tracking Number:	17FY

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	CDC-INFO Email Survey	CDC-INFO Email Survey_2016.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,000	9,000
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Generic Clearance Submission Template_2016_Email Survey.docx	12/05/2016

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