Information Collection

CDC Template Navigation

IC 229828 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⚠️ Notice: This information collection may be referencing outdated material.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
F - Activities-CDC-Template-Nav-2018 OMB.DOCX	Other-Discussion guide
A-fast-track-PRA-submission-short-form-cdc_template_navigation_2018.docx Request for Approval	IC Document
C-Testing Plan - CDC-Template-Nav-2018 OMB.DOCX Testing Plan	IC Document
D - Instructions -CDC-Template-Nav-2018 OMB.DOCX Facilitator Introduction	IC Document
E-Consent Forms -CDC-Template-Nav-2018 OMB.DOCX Consent	IC Document

IC Title:

CDC Template Navigation

Agency IC Tracking Number:

0920-1050-18MI

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Discussion guide			F - Activities-CDC-Template-Nav-2018 OMB.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 40 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	A-fast-track-PRA-submission-short-form-cdc_template_navigation_2018.docx	01/24/2018
Testing Plan	C-Testing Plan - CDC-Template-Nav-2018 OMB.DOCX	01/24/2018
Facilitator Introduction	D - Instructions -CDC-Template-Nav-2018 OMB.DOCX	01/24/2018
Consent	E-Consent Forms -CDC-Template-Nav-2018 OMB.DOCX	01/24/2018

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