Information Collection

Assessment of STLT Public Health Agencies to Guide the Update of CDC/ATSDR Cancer Cluster Guidelines

IC 242670 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Assessment of STLT Public Health Agencies to Guide the Update of CDC/ATSDR Cancer Cluster Guidelines	Form
AttC_FocusGroupFacilitatorsGuide.docx	Other-Focus group guide
Assessment -word AttA_Assessment_WordVersion.docx	Form
Assessment - web AttB_Survey_WebVersion.pdf	Form
AttD_InvitationEmail.docx Invitation email	IC Document
AttE_ReminderEmail.docx Reminder email	IC Document
AttF_FocusGroupDiscussion_ReminderEmail.docx Focus group reminder	IC Document
AttG_ATSDR Regions.docx Regions	IC Document
CCGDLNS-SSA.docx Supporting statement A	IC Document
CCGDLNS-SSB.docx Supporting statement B	IC Document

IC Title:

Assessment of STLT Public Health Agencies to Guide the Update of CDC/ATSDR Cancer Cluster Guidelines

Agency IC Tracking Number:

0920-0879-20QF

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Assessment -word	AttA_Assessment_WordVersion.docx	Yes	Yes	Fillable Fileable
Form	none	Assessment - web	AttB_Survey_WebVersion.pdf	Yes	Yes	Fillable Fileable
Other-Focus group guide			AttC_FocusGroupFacilitatorsGuide.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,190

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	3,190	3,190
Annual IC Time Burden (Hours)	1,715	1,715
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Invitation email	AttD_InvitationEmail.docx	07/13/2020
Reminder email	AttE_ReminderEmail.docx	07/13/2020
Focus group reminder	AttF_FocusGroupDiscussion_ReminderEmail.docx	07/13/2020
Regions	AttG_ATSDR Regions.docx	07/13/2020
Supporting statement A	CCGDLNS-SSA.docx	07/13/2020
Supporting statement B	CCGDLNS-SSB.docx	07/13/2020

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