Assessment of Gonorrhea Case Interviewing in SSuN Sites

Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Document Name Document Type
Att 2a_Interview Guide for Staff.docx Other-Interview Guide
Att 2b_Interview Guide for Supervisors.docx Other-Interview Guide
SS A.docx Supporting Statement A IC Document
SS B.docx Supporting Statement B IC Document
Att 1_Informed Consent.docx Consent IC Document
Att 3_7206 CDC IRB approval.docx IRB Approval IC Document
Att 4 PIA Form approved 10 Jun 2019.pdf PIA IC Document

Information Collection (IC) Details

IC Title:	Assessment of Gonorrhea Case Interviewing in SSuN Sites	Agency IC Tracking Number:	0920-0840-19BNN

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
Other-Interview Guide			Att 2a_Interview Guide for Staff.docx		Yes	No	Paper Only
Other-Interview Guide			Att 2b_Interview Guide for Supervisors.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	50
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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