CDC Latent Tuberculosis Infection Mobile App 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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.