Information Collection

Customer Feedback from CDC-Funded CBO about Rapid Feedback Reports

IC 235925 under ICR 201705-0920-017 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer Feedback from CDC-Funded CBO about Rapid Feedback Reports	Form
Web Assessment Fast Track Request_att 2_Web Assessment Screenshots.docx	Form
PD 7211 PEB_CBO_RFR Survey Non Research Determination Form LJF.pdf Non-research determination	IC Document
Fast Track Request_att 1_Web Assessment Questions.docx Web Assessment - word version	IC Document
Fast Track Request Form_Customer Feedback.docx Request for Approval	IC Document

IC Title:

Customer Feedback from CDC-Funded CBO about Rapid Feedback Reports

Agency IC Tracking Number:

0920-1027-19AQJ

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	none	Web Assessment	Fast Track Request_att 2_Web Assessment Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 238

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	476	476
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Non-research determination	PD 7211 PEB_CBO_RFR Survey Non Research Determination Form LJF.pdf	05/02/2019
Web Assessment - word version	Fast Track Request_att 1_Web Assessment Questions.docx	05/02/2019
Request for Approval	Fast Track Request Form_Customer Feedback.docx	05/02/2019

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