Implementing Public Health Genomics in Your State: Resources from CDC Office of Public Health

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
Form 0920-17FC Implementing Public Health Genomics in Your State: Resources from CDC Office of Public Health Form and Instruction
Webinar Survey Invitation.docx Instruction
0920-17FC Genomics Survey for Webinar 2016_11_18 Genomics Survey for Webinar 2016_11_18.xlsx Form and Instruction
11_7 Fast_Track_GenIC_RequestTemplate OPHG_resources_webinar rev LEC 2016_.docx 11_7 Fast_Track_GenIC_RequestTemplate OPHG_resources_webinar rev LEC 2016_ IC Document
New Requirements for Supporting Statement A.docx New Requirements for Supporting Statement A IC Document

Information Collection (IC) Details

IC Title:	Implementing Public Health Genomics in Your State: Resources from CDC Office of Public Health	Agency IC Tracking Number:	17FC

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	0920-17FC	Genomics Survey for Webinar 2016_11_18	Genomics Survey for Webinar 2016_11_18.xlsx		Yes	Yes	Fillable Fileable
Instruction			Webinar Survey Invitation.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	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	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
11_7 Fast_Track_GenIC_RequestTemplate OPHG_resources_webinar rev LEC 2016_	11_7 Fast_Track_GenIC_RequestTemplate OPHG_resources_webinar rev LEC 2016_.docx	11/23/2016
New Requirements for Supporting Statement A	New Requirements for Supporting Statement A.docx	11/23/2016

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