Information Collection

Knowledge, Attitudes, and Practices of Healthcare Professionals Working in Schools Regarding Tickborne Disease Prevention and Lyme Disease in New York State and Maryland

IC 235465 under ICR 201606-0920-021 · OMB 0920-1150.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1150 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1150 Knowledge, Attitudes, and Practices of Healthcare Professionals Working in Schools Regarding Tickborne Disease Prevention and Lyme Disease in New York State and Maryland	Form and Instruction
0920-1150 HPWS Survey (online) Attachment_1_HPWS_Survey (Online).pdf	Form and Instruction
0920-1150 HPWS Survey (mail) Attachment_1_HPWS Survey (Mail).docx	Form and Instruction
Attachment_2_Human_Subjects_010219AB.pdf HS Determination	IC Document
Attachment_3_NY_Invitation_Postcard.pdf NY Invitation Postcard	IC Document
Attachment_4_NY_Invitation_Flyer_for_Mailing.pdf NY Invitation Flyer for mailing	IC Document
Attachment_5_NY_Invitation_Flyer_for_Email.pdf NY Invitation Flyer for email	IC Document
Attachment_6_NY_Reminder_Postcard.pdf NY Reminder Postcard	IC Document
Attachment_7_NY_Reminder_Flyer_for_Mailing.pdf NY Reminder Flyer for mailing	IC Document
Attachment_8_NY_Reminder_Flyer_for_Email.pdf NY Reminder Flyer for email	IC Document
Attachment_9_MD_Invitation_Flyer_for_Mailing.pdf MD Invitation Flyer for mailing	IC Document
Attachment_10_MD_Invitation_Flyer_for_Email.pdf MD Invitation Flyer for email	IC Document
Attachment_11_MD_Reminder_Postcard.pdf MD Reminder Postcard	IC Document
Attachment_12_MD_Reminder_Flyer_for_Email.pdf MD Reminder Flyer for email	IC Document
Attachment_13_HPWS_Project_Website.pdf HPWS Project Website	IC Document
Attachment_14_MD IRB approval letter 030719.pdf MD IRB approval letter	IC Document
Attachment_15_NY_IRB_Approval_Letter.pdf NY IRB Approval letter	IC Document
SS A_GenIC_SBHP final.docx SSA	IC Document
SS B_GenIC_SBHP.docx SSB	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Knowledge, Attitudes, and Practices of Healthcare Professionals Working in Schools Regarding Tickborne Disease Prevention and Lyme Disease in New York State and Maryland

Agency IC Tracking Number:

0920-1150-19AHT

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
Form and Instruction	0920-1150	HPWS Survey (online)	Attachment_1_HPWS_Survey (Online).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1150	HPWS Survey (mail)	Attachment_1_HPWS Survey (Mail).docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,951

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,951	3,951
Annual IC Time Burden (Hours)	264	264
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HS Determination	Attachment_2_Human_Subjects_010219AB.pdf	03/27/2019
NY Invitation Postcard	Attachment_3_NY_Invitation_Postcard.pdf	03/27/2019
NY Invitation Flyer for mailing	Attachment_4_NY_Invitation_Flyer_for_Mailing.pdf	03/27/2019
NY Invitation Flyer for email	Attachment_5_NY_Invitation_Flyer_for_Email.pdf	03/27/2019
NY Reminder Postcard	Attachment_6_NY_Reminder_Postcard.pdf	03/27/2019
NY Reminder Flyer for mailing	Attachment_7_NY_Reminder_Flyer_for_Mailing.pdf	03/27/2019
NY Reminder Flyer for email	Attachment_8_NY_Reminder_Flyer_for_Email.pdf	03/27/2019
MD Invitation Flyer for mailing	Attachment_9_MD_Invitation_Flyer_for_Mailing.pdf	03/27/2019
MD Invitation Flyer for email	Attachment_10_MD_Invitation_Flyer_for_Email.pdf	03/27/2019
MD Reminder Postcard	Attachment_11_MD_Reminder_Postcard.pdf	03/27/2019
MD Reminder Flyer for email	Attachment_12_MD_Reminder_Flyer_for_Email.pdf	03/27/2019
HPWS Project Website	Attachment_13_HPWS_Project_Website.pdf	03/27/2019
MD IRB approval letter	Attachment_14_MD IRB approval letter 030719.pdf	03/27/2019
NY IRB Approval letter	Attachment_15_NY_IRB_Approval_Letter.pdf	03/27/2019
SSA	SS A_GenIC_SBHP final.docx	03/27/2019
SSB	SS B_GenIC_SBHP.docx	03/27/2019

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