Information Collection

Lyme and Other Tickborne Diseases Knowledge, Attitude, and Practice Surveys

IC 236577 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⚠️ Notice: This information collection may be referencing outdated material.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 Lyme and Other Tickborne Diseases Knowledge, Attitude, and Practice Surveys	Form and Instruction
0920-1150 Main Survey 4. UpperMidwestTickPreventionStudy_MN20190621.pdf	Form and Instruction
0920-1150 Survey Screener 4a. Survey Introduction Eligibility.pdf	Form and Instruction
1. Counties for Recruitment.docx Counties for Recruitment	IC Document
2. Survey Invitation Postcard Remind.docx Invitation Reminder postcard	IC Document
3. Survey Invitation Postcard.docx Invitation Postcard	IC Document
5. Thank You Letter.docx Thank You Letter	IC Document
6. Withdrawal Letter.docx Withdrawal Letter	IC Document
7. CDC Study Website.docx CDC Study Website	IC Document
8. HRPO Exemption Determination.docx IRB Determination	IC Document
SSA (Kevin Joyce v2)_edited_6.21.19.docx SSA	IC Document
SSB.docx SSB	IC Document

IC Title:

Lyme and Other Tickborne Diseases Knowledge, Attitude, and Practice Surveys

Agency IC Tracking Number:

0920-1150-19BHO

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	Main Survey	4. UpperMidwestTickPreventionStudy_MN20190621.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1150	Survey Screener	4a. Survey Introduction Eligibility.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,931

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,931	5,931
Annual IC Time Burden (Hours)	396	396
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Counties for Recruitment	1. Counties for Recruitment.docx	06/24/2019
Invitation Reminder postcard	2. Survey Invitation Postcard Remind.docx	06/24/2019
Invitation Postcard	3. Survey Invitation Postcard.docx	06/24/2019
Thank You Letter	5. Thank You Letter.docx	06/24/2019
Withdrawal Letter	6. Withdrawal Letter.docx	06/24/2019
CDC Study Website	7. CDC Study Website.docx	06/24/2019
IRB Determination	8. HRPO Exemption Determination.docx	06/24/2019
SSA	SSA (Kevin Joyce v2)_edited_6.21.19.docx	06/24/2019
SSB	SSB.docx	06/24/2019

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