CDC Template Navigation

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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

IC Title:	CDC Template Navigation	Agency IC Tracking Number:	0920-1050-18MI

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
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 %

	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

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.