Information Collection

Prevention and Control of Shigellosis: A Needs Assessment of State and Local Health Departments

IC 231502 under ICR 201711-0920-012 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Prevention and Control of Shigellosis: A Needs Assessment of State and Local Health Departments Form and Instruction
Telephone Interview guide Attachment A_Telephone Interview Guide.docx Form and Instruction
SHIGELLA-SSA.DOCX Supporting Statement Part A IC Document
SHIGELLA-SSB.DOCX Supporting Statement Part B IC Document
Attachment B_Invitation Email.docx Invitation Email IC Document
Attachment C_Announcement.docx Announcement IC Document
Attachment D_Reminder Email.docx Reminder Email IC Document
Attachment E_Thank You Email.docx Thank You Email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Prevention and Control of Shigellosis: A Needs Assessment of State and Local Health Departments	Agency IC Tracking Number:	0920-18AHI

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	Telephone Interview guide	Attachment A_Telephone Interview Guide.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	3,292	3,292

Documents for IC

Title	Document	Date Uploaded
Supporting Statement Part A	SHIGELLA-SSA.DOCX	05/17/2018
Supporting Statement Part B	SHIGELLA-SSB.DOCX	05/17/2018
Invitation Email	Attachment B_Invitation Email.docx	05/17/2018
Announcement	Attachment C_Announcement.docx	05/17/2018
Reminder Email	Attachment D_Reminder Email.docx	05/17/2018
Thank You Email	Attachment E_Thank You Email.docx	05/17/2018

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