Information Collection

Pandemic Influenza: Assessing the Feasibility and Acceptability of Implementing the 2017 Community Mitigation Guidelines and Recommendations (CMG-EVAL)

IC 236347 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⚠️ Notice: This information collection may be referencing outdated material.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
Pandemic Influenza: Assessing the Feasibility and Acceptability of Implementing the 2017 Community Mitigation Guidelines and Recommendations (CMG-EVAL) Form and Instruction
CMG-EVAL-Attachment C-Instrument Word Version.docx Other-Word version of survey to faci
SurveyMonkey Survey for the Directors of Public Health P CMG-EVAL-Attachment D-Instrument Web Version-SurveyMonkey.docx Form and Instruction
Qualtrics Survey for Local Health Department Preparednes CMG-EVAL-Attachment E-Instrument Web Version-Qualtrics.docx Form and Instruction
CMG-EVAL-SSA.docx Supporting Statement Part A IC Document
CMG-EVAL-SSB.docx Supporting Statement Part B IC Document
CMG-EVAL-Attachment A-Respondent Universe and Sample Tables.docx Respondent Universe and Sample Tables IC Document
CMG-EVAL-Attachment B-NPIs Reserved for Influenza Pandemics Table.docx Table Summary of Non-Pharmaceutical Interventions Reserved for Influenza Pandemics IC Document
CMG-EVAL-Attachment F-Recruitment E-mail Invitation.docx Recruitment Email Invitation IC Document
CMG-EVAL-Attachment G-Reminder E-mail Notice-No Response Yet.docx Reminder Email for Non-Response IC Document
CMG-EVAL-Attachment H-Reminder E-mail Notice-Partial Response.doc Reminder Email for Partial Response IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pandemic Influenza: Assessing the Feasibility and Acceptability of Implementing the 2017 Community Mitigation Guidelines and Recommendations (CMG-EVAL)	Agency IC Tracking Number:	0920-0879-19AYW

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	SurveyMonkey Survey for the Directors of Public Health Preparedness	CMG-EVAL-Attachment D-Instrument Web Version-SurveyMonkey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Qualtrics Survey for Local Health Department Preparedness Coordinators	CMG-EVAL-Attachment E-Instrument Web Version-Qualtrics.docx	Yes	Yes	Fillable Fileable
Other-Word version of survey to facilitate review of content			CMG-EVAL-Attachment C-Instrument Word Version.docx	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 878	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	878	878
Annual IC Time Burden (Hours)	1,317	1,317
Annual IC Cost Burden (Dollars)	48,501	48,501

Documents for IC

Title	Document	Date Uploaded
Supporting Statement Part A	CMG-EVAL-SSA.docx	06/04/2019
Supporting Statement Part B	CMG-EVAL-SSB.docx	06/04/2019
Respondent Universe and Sample Tables	CMG-EVAL-Attachment A-Respondent Universe and Sample Tables.docx	06/04/2019
Table Summary of Non-Pharmaceutical Interventions Reserved for Influenza Pandemics	CMG-EVAL-Attachment B-NPIs Reserved for Influenza Pandemics Table.docx	06/04/2019
Recruitment Email Invitation	CMG-EVAL-Attachment F-Recruitment E-mail Invitation.docx	06/04/2019
Reminder Email for Non-Response	CMG-EVAL-Attachment G-Reminder E-mail Notice-No Response Yet.docx	06/04/2019
Reminder Email for Partial Response	CMG-EVAL-Attachment H-Reminder E-mail Notice-Partial Response.doc	06/04/2019

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