Information Collection

CDC Latent Tuberculosis Infection Mobile App Survey

IC 227641 under ICR 201605-0920-001 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-17AUP CDC Latent Tuberculosis Infection Mobile App Survey	Form and Instruction
0920-17AUP Attachment A_LTBI Mobile App Survey Questions Attachment A_LTBI Mobile App Survey Questions.docx	Form and Instruction
0920-17AUP Attachment B_LTBI Mobile App Survey_Current Users_Screen Attachment B_LTBI Mobile App Survey_Current Users_Screenshots.docx	Form and Instruction
0920-17AUP Attachment C_LTBI Mobile App Survey_Potential Users_Scre Attachment C_LTBI Mobile App Survey_Potential Users_Screenshots.docx	Form and Instruction
LTBI Mobile App Survey_Generic Clearance Template.docx LTBI Mobile App Survey_Generic Clearance Template	IC Document
LTBI Mobile App Survey_Recruitment Messages.docx LTBI Mobile App Survey_Recruitment Messages	IC Document

IC Title:

CDC Latent Tuberculosis Infection Mobile App Survey

Agency IC Tracking Number:

0920-17AUP

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-17AUP	Attachment A_LTBI Mobile App Survey Questions	Attachment A_LTBI Mobile App Survey Questions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-17AUP	Attachment B_LTBI Mobile App Survey_Current Users_Screenshots	Attachment B_LTBI Mobile App Survey_Current Users_Screenshots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-17AUP	Attachment C_LTBI Mobile App Survey_Potential Users_Screenshots	Attachment C_LTBI Mobile App Survey_Potential Users_Screenshots.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
LTBI Mobile App Survey_Generic Clearance Template	LTBI Mobile App Survey_Generic Clearance Template.docx	07/21/2017
LTBI Mobile App Survey_Recruitment Messages	LTBI Mobile App Survey_Recruitment Messages.docx	07/21/2017

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