2018 Public Health Ethics Forum

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1050 2018 Public Health Ethics Forum Form and Instruction
0920-1050 PHE Forum Survey Attachment A.docx omhhe.az1.qualtrics.com/jfe/form/SV_8k8IrX1WcWZJH3D Form and Instruction
2018 Public Health Ethics Forum (PHEF) genIC - 9-7-18.docx PHE Forum Generic Template IC Document
Attachment B.docx Email template IC Document
Attachment C.docx Qualtrics Survey Options IC Document
Attachment D.docx Forum Agenda IC Document

Information Collection (IC) Details

IC Title:	2018 Public Health Ethics Forum	Agency IC Tracking Number:	0920-1050-18AZU

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 and Instruction	0920-1050	PHE Forum Survey	Attachment A.docx	https://omhhe.az1.qualtrics.com/jfe/form/SV_8k8IrX1WcWZJH3D	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PHE Forum Generic Template	2018 Public Health Ethics Forum (PHEF) genIC - 9-7-18.docx	09/12/2018
Email template	Attachment B.docx	09/12/2018
Qualtrics Survey Options	Attachment C.docx	09/12/2018
Forum Agenda	Attachment D.docx	09/12/2018

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