Information Collection

Assessment of Gonorrhea Case Interviewing in SSuN Sites

IC 237285 under ICR 201808-0920-023 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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.