Applicability and Use of The Community Guide Among National Association of County and City Health Officials (NACCHO) Members

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

Documents and Forms

Document Name Document Type
Applicability and Use of The Community Guide Among National Association of County and City Health Officials (NACCHO) Members Form and Instruction
Applicability and Use of The Community Guide Among NACCH Screenshots of NACCHO Survey 2-2-17.docx Form and Instruction
Provide Feedback on The Community Guide invitation email script NACCHO 2-2-17.docx Email Invitation to Participate IC Document
Provide Feedback on The Community Guide follow-up email script NACCHO 2-2-17.docx Email Follow-up Reminder IC Document
Fast_Track_GenIC_Request CGB Customer feedback NACCHO 2-2-2017.docx Template Request IC Document

Information Collection (IC) Details

IC Title:	Applicability and Use of The Community Guide Among National Association of County and City Health Officials (NACCHO) Members	Agency IC Tracking Number:	0920-17PA

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	N/A	Applicability and Use of The Community Guide Among NACCHO Members (screenshots)	Screenshots of NACCHO Survey 2-2-17.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	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	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email Invitation to Participate	Provide Feedback on The Community Guide invitation email script NACCHO 2-2-17.docx	02/02/2017
Email Follow-up Reminder	Provide Feedback on The Community Guide follow-up email script NACCHO 2-2-17.docx	02/02/2017
Template Request	Fast_Track_GenIC_Request CGB Customer feedback NACCHO 2-2-2017.docx	02/02/2017

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