Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1050 Webinar Polling Questions	Form and Instruction	New	Repair queued
Form 0920-1050 Network Member Survey	Form and Instruction	New	Repair queued
Form 0920-1050 NAC Post-site Visit Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Webinar Webcast Workshop Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Federal Select Agent Program (FSAP) and Import Permit Program (IPP) Inspection Survey	Form and Instruction	New	Repair queued
Form 0920-22EV DLS External Partner Discussion Group 1-7	Form and Instruction	New	Repair queued
Form 0920-22EU Att1-On-TRAC Survey	Form and Instruction	New	Repair queued
Form 0920-1050 2022 EIS MATCH Customver Service Feedback Survey	Form and Instruction	New	Repair queued
Form 0920-1050 2022 EIS Conference Customer Service Feedback Survey	Form and Instruction	New	Repair queued
Form 0920-1050 DSEPD Fellowship Webinar Customer Service Feedback Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Dating Matters Rebranding Research	Form and Instruction	New	Repair queued
Form 0920-1050 Tools or Resource Survey	Form and Instruction	New	Repair queued
Form 0920-1050 PIB Training Survey	Form and Instruction	New	Repair queued
Survey Consent and Questionnaire	Form and Instruction	New	Repair queued
Survey Recruitment Materials	Form and Instruction	New	Repair queued
Interview Consent and Interview Guide	Form and Instruction	New	Repair queued
Interview Recruitment Materials	Form and Instruction	New	Repair queued
Consent and Interview Guide	Form and Instruction	New	Repair queued
Interview Scheduling	Form and Instruction	New	Repair queued
Screening Form	Form and Instruction	New	Repair queued
Recruitment Materials	Form and Instruction	New	Repair queued
Form 0920-22EK Att. A NCIPC Fellowship and Internship Evaluation Feedback V3.4.18.22	Form and Instruction	New	Repair queued
Form 0920-1050 Survey - mobile	Form and Instruction	New	Repair queued
Form 0920-1050 Survey - web	Form and Instruction	New	Repair queued
Form 0920-1050 Survey - word	Form and Instruction	New	Repair queued
Form 0920-1050 IVR Survey (Private)	Form and Instruction	New	Repair queued
Form 0920-1050 IVR Survey (Individual)	Form and Instruction	New	Repair queued
Form 0920-1050 Email Survey Questionnaire	Form and Instruction	New	Repair queued
Form 0920-1050 Email Survey Questionnaire	Form and Instruction	New	Repair queued
Form 0920-22EE Att_6_0920-1050_2022_EIS_Match_Cust_Serv_Fdbk_Survey	Form and Instruction	New	Repair queued
Form 0920-22EE Att_1_0920-1050_2022_EIS_Conf_Cust_Serv_Fdbk_Survey	Form	New	Repair queued
Form 0920-22DN Evaluation of the DHDD Spanish Websites Communication Materials	Form and Instruction	New	Repair queued
Form 0920-1050 SimpleReport TouchPoint Survey	Form	New	Repair queued
Help Improve ReportStream!	Form and Instruction	New	Repair queued
Form 0920-1050 Survey of NJ Local and County Public Health Agencies Regarding Tick and Tick=borne Disease Managment	Form and Instruction	New	Repair queued
Form 0920-1050 A Survey of NJ Mosquito Control Agencies Regarding the Management of Ticks and Tick-borne Disease	Form	New	Repair queued
Form 0920-1050 Survey Questionnaire	Form and Instruction	New	Repair queued
NERD Academy Webpage Survey (screenshots)	Form and Instruction	New	Repair queued
NERD Academy Participant Survey (screenshots)	Form and Instruction	New	Repair queued
Form 0920-22AZ 20211025_CDC-INFO Post Chat Survey V5	Form and Instruction	New	Repair queued
Form 0920-1050 Post Event Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Registration Form	Form and Instruction	New	Repair queued
Form 0920-1050 U.S. National Authority for the Containment of Polio Webinar Survey	Form	New	Repair queued
Form 0920-22AF NIOSH Foresight Friday Webinar	Form and Instruction	New	Repair queued
CDC Fellowship Recruitment Event Feedback Survey	Form and Instruction	New	Repair queued
Form 0920-21IJ 2020-2021 CDC Science Ambassador Program Activities Survey	Form and Instruction	New	Repair queued
Form ETSB_2021_Cust_Sat 0920-21HQ	Form	New	Repair queued
DGHT SIB Training Assessment Form	Form and Instruction	New	Repair queued
Form 0920-1050 Feedback Survey for 2021 Sept Webinar	Form and Instruction	New	Repair queued
Clinical Lab Partners Forum Survey 2021	Form and Instruction	New	Repair queued
Form 0920-0879 Strategic Scholars Participant Survey	Form and Instruction	New	Repair queued
Form 0920-1050 2021 EIS Customer Feedback Survey	Form and Instruction	New	Repair queued
EEP Alumni Survey - screenshots	Form	New	Repair queued
EEP Alumni Survey - word	Form	New	Repair queued
PHIT Survey - mobile	Form	New	Repair queued
PHIT Survey - web	Form	New	Repair queued
PHIT Survey - word	Form	New	Repair queued
Tools and Resources Survey	Form	New	Repair queued
Training Feedback	Form	New	Repair queued
Form 0920-1050 On-TRAC Customer Feedback Survey	Form	New	Repair queued
Form 0920-1050 Usability Testing Interview Guide - STRYVE	Form and Instruction	New	Repair queued
Form 0920-1050 Usability Testing Interview Guide - Veto Violence	Form and Instruction	New	Repair queued
Form 0920-1050 Follow-Up Email	Form and Instruction	New	Repair queued
Form 0920-1050 Participation Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Invitation Email	Form and Instruction	New	Repair queued
Form 0920-1050 Operational Planning Workshops Survey	Form and Instruction	New	Repair queued
2021 CDC Laboratory Training Courses Learner Feedback Survey (External Audiences)	Form and Instruction	New	Repair queued
Form 0920-21CR FSAP Survey	Form	New	Repair queued
Form 0920-1050 Post Site Visit Survey	Form	New	Available
Form PIDS User Feedback 0920-21BX	Form and Instruction	New	Available
Form 0920-1050 Training Effectiveness Follow-up (Spring)	Form and Instruction	New	Available
Form 0920-1050 Training Effectiveness Follow-up (Fall)	Form and Instruction	New	Available
Form 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (5 surveys)	Form and Instruction	New	Available
Form 0920-1050 Training Effectiveness Follow-up (Spring)	Form and Instruction	New	Available
Form 09201050 Training Effectiveness Follow-up (Fall)	Form and Instruction	New	Available
Form 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (4 surveys)	Form and Instruction	New	Available
Form 0920-1050 Training Effectiveness Follow-up (Spring)	Form and Instruction	New	Available
Form 0920-1050 Training Effectiveness Follow-up (Fall)	Form and Instruction	New	Available
Form 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (3 surveys)	Form and Instruction	New	Available
Form 0920-1050 Training Effectiveness Follow-up (Spring)	Form and Instruction	New	Available
Form 0920-1050 Training Effectiveness Follow-up (Fall)	Form and Instruction	New	Available
Form 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (2 surveys)	Form and Instruction	New	Available
Form 0920-1050 Training Effectiveness Follow-up (Fall) OR Training Effectiveness Follow-up (Spring)	Form and Instruction	New	Available
Form 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (1 survey)	Form and Instruction	New	Available
Form 0920-1050 Respondents - No Attendance Session Scheduling (Spring)	Form and Instruction	New	Available
Form 0920-1050 Respondents - No Attendance Session Scheduling (Fall)	Form and Instruction	New	Available
Form 0920-21BA US NAC Webinar Polling Questions	Form and Instruction	New	Available
Screenshots	Form	New	Available
Usability Testing Instrument	Form	New	Available
Form 0920-1050 2020 Reverse Site Visit Feedback Form	Form and Instruction	New	Available
Form 0920-1050 Healthcare Provider - Acute Pain Moderator Guide	Form and Instruction	New	Available
Form 0920-1050 Healthcare Provider - Drug Overdose Moderator Guide	Form and Instruction	New	Available
Form 0920-1050 Healthcare Provider Screener	Form and Instruction	New	Available
Form 0920-1050 Individual - Marijuana Moderator Guide	Form and Instruction	New	Available
Form 0920-1050 Individual - Rx Awareness Moderator Guide	Form and Instruction	New	Available
Form 0920-1050 Individual Screener	Form and Instruction	New	Available
Form 0920-1050 Customer Feedback Forensic Toxicology	Form and Instruction	New	Available
Form 0920-20QM 2020 Science Ambassador Virtual Training Series Satisfaction Survey	Form and Instruction	New	Available
Form 0920-20QB Usability_Testing_Discussion_Guide	Form and Instruction	New	Available
Form 0920-20QB Participant_Screener	Form and Instruction	New	Available
Form 0920-1050 SPARC Survey	Form and Instruction	New	Available
Form 0920-20OP Online Feedback Opioid Guides	Form and Instruction	New	Available
Form 0920-1050 2020 Annual Evaluators' Network Member Survey	Form	New	Available
Customer Satisfaction Survey 2020	Form	New	Available
Form 0920-20OI 2020 EIS Virtual Recruitment and Match Customer Service Survey	Form and Instruction	New	Available
Form 0920-1050 Participant Screening Form	Form	New	Available
Form 0920-1050 2020 CDC Laboratory Courses for External Audiences Learner Feedback Survey	Form and Instruction	New	Available
Stakehold Engagement	Form and Instruction	New	Available
Form 0920-1050 2020 Science Ambassador Application Survey	Form and Instruction	New	Available
Form 3 Month Follow up 0920-20LD	Form and Instruction	New	Available
Form 0920-20IS 2020 Science Ambassador Regional Training Workshop Satisfaction Survey	Form and Instruction	New	Available
WISQARS User Survey	Form and Instruction	New	Available
Form 0920-1050 Remote Interview Guide	Form and Instruction	New	Available
Form 0920-1050 Online Survey - Interview Guide	Form and Instruction	New	Available
Form 0920-1050 Connection Selector Survey	Form and Instruction	New	Available
Form 0920-1050 Violence Prevention in Practice	Form	New	Available
Form 0920-1050 Peer Reviewers Evaluation Form	Form and Instruction	New	Available
Form 0920-20DJ 920-20DJ	Form and Instruction	New	Available
CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey	Form and Instruction	New	Available
Form 0920-1050 BSC / CFH / Centrifuge Learner Survey	Form and Instruction	New	Available
Form 0920-1050 Customer Survey	Form and Instruction	New	Available
eLearning Course Feedback Survey	Form	New	Available
CDC Import Permit Program (IPP) Inspection Feedback Survey	Form and Instruction	New	Available
Interactive Voice Response Survey (Spanish language)	Form and Instruction	New	Available
Interactive Voice Response Survey (English language)	Form and Instruction	New	Available
Survey (Spanish)	Form and Instruction	New	Available
Survey (English language)	Form and Instruction	New	Available
Survey (Spanish language)	Form and Instruction	New	Available
Survey (English language)	Form and Instruction	New	Available
Survey (Spanish language)	Form and Instruction	New	Available
Survey (English language)	Form and Instruction	New	Available
Form 0920-1050 NNPHI (PHIT End of Training Survey)	Form and Instruction	New	Available
Form 0920-1050 NNPHI (Public Health Improvement Training Reaction Survey)	Form and Instruction	New	Available
Interview Protocol - Assessment of NPHI Capacity	Form and Instruction	New	Available
ETSB Customer Satisfaction Survey	Form	New	Available
Form 0920-1050 Preparedness Field Assignee Alumni Survey	Form and Instruction	New	Available
Form 0920-1050 PHIT End of Training Survey - Web version	Form and Instruction	New	Available
Form 0920-1050 PHIT End of Session Survey - Web version	Form and Instruction	New	Available
Interview guide exploring crosscutting areas associated with sustainability	Form and Instruction	New	Available
Form 0920-1050 User Testing Questions for STD Tx Guide Mobile App and Website	Form and Instruction	New	Available
Customer Service GenIC Clearance Template (Final 5.3).docx	Supplementary Document	Uploaded 2019-05-03	Available
2018-05915.pdf	Supplementary Document	Uploaded 2019-02-28	Available
SSB fast track revision.docx	Supporting Statement B	Uploaded 2019-02-28	Available
SSA fast track revision.docx	Supporting Statement A	Uploaded 2019-02-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
253302	United States National Authority for the Containment of Polio (NAC) Webinar Survey and Polling Questions	Form and Instruction	New	Webinar Polling Questions
253301	Evaluators' Network, Member Survey	Form and Instruction	New	Network Member Survey
253226	Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement	Form and Instruction	New	NAC Post-site Visit Survey
253218	DSAT Webinar, Webcast, and Workshop Survey	Form and Instruction	New	Webinar Webcast Workshop Survey
253202	IPP and FSAP Inspection Survey	Form and Instruction	New	Federal Select Agent Program (FSAP) and Import Permit Program (IPP) Inspection Survey
253092	External Partner Discussion Groups to Inform Strategic Planning of CDC's Division of Laboratory Systems	Form and Instruction	New	DLS External Partner Discussion Group 1-7
253090	On-TAC Customer Service Survey	Form and Instruction	New	Att1-On-TRAC Survey
253089	2022 EIS Conference and Match Feedback Surveys	Form and Instruction	New	2022 EIS MATCH Customver Service Feedback Survey
253089	2022 EIS Conference and Match Feedback Surveys	Form and Instruction	New	2022 EIS Conference Customer Service Feedback Survey
253063	DSEPD Fellowship Webinar Customer Service Feedback Survey	Form and Instruction	New	DSEPD Fellowship Webinar Customer Service Feedback Survey
253062	Dating Matters Rebranding Research	Form and Instruction	New	Dating Matters Rebranding Research
253062	Dating Matters Rebranding Research	Other-Text	New
253058	DSLR Tools and Resources Survey	Form and Instruction	New	Tools or Resource Survey
253055	DSLR Training Survey	Form and Instruction	New	PIB Training Survey
253053	[2022] VetoViolence Training and Resource Development - Health Equity	Form and Instruction	New	Survey Consent and Questionnaire
253053	[2022] VetoViolence Training and Resource Development - Health Equity	Form and Instruction	New	Survey Recruitment Materials
253053	[2022] VetoViolence Training and Resource Development - Health Equity	Form and Instruction	New	Interview Consent and Interview Guide
253053	[2022] VetoViolence Training and Resource Development - Health Equity	Form and Instruction	New	Interview Recruitment Materials
253052	[2022] Select Adapt Evaluate - VetoViolence Usability Testing	Form and Instruction	New	Consent and Interview Guide
253052	[2022] Select Adapt Evaluate - VetoViolence Usability Testing	Form and Instruction	New	Interview Scheduling
253052	[2022] Select Adapt Evaluate - VetoViolence Usability Testing	Form and Instruction	New	Screening Form
253052	[2022] Select Adapt Evaluate - VetoViolence Usability Testing	Form and Instruction	New	Recruitment Materials
253025	National Center for Injury Prevention and Control (NCIPC) Fellows & Interns' Evaluation	Form and Instruction	New	Att. A NCIPC Fellowship and Internship Evaluation Feedback V3.4.18.22
253025	National Center for Injury Prevention and Control (NCIPC) Fellows & Interns' Evaluation	Other-Screenshoot survey	New
253011	Public Health Improvement Training Attendee Reaction Survey	Form and Instruction	New	Survey - mobile
253011	Public Health Improvement Training Attendee Reaction Survey	Form and Instruction	New	Survey - web
253011	Public Health Improvement Training Attendee Reaction Survey	Form and Instruction	New	Survey - word
252889	CDC-INFO Interactive Voice Response (IVR) Satisfaction Survey (for Private Respondents Who Inquirer by Phone)	Form and Instruction	New	IVR Survey (Private)
252888	CDC-INFO Interactive Voice Response (IVR) Satisfaction Survey (for Individual Respondents Who Inquirer by Phone)	Form and Instruction	New	IVR Survey (Individual)
252886	CDC-INFO Web-based Satisfaction Survey (for Private Respondents Who Send Email Inquiries)	Form and Instruction	New	Email Survey Questionnaire
252862	CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)	Form and Instruction	New	Email Survey Questionnaire
252850	2022 EpiEpidemic Intelligence Service (EIS) Conference and Match Feedback Surveys	Form and Instruction	New	Att_6_0920-1050_2022_EIS_Match_Cust_Serv_Fdbk_Survey
252850	2022 EpiEpidemic Intelligence Service (EIS) Conference and Match Feedback Surveys	Form	New	Att_1_0920-1050_2022_EIS_Conf_Cust_Serv_Fdbk_Survey
252319	Evaluation of Spanish Webpages (CDC/DHDD)	Form and Instruction	New	Evaluation of the DHDD Spanish Websites Communication Materials
252250	SimpleReport Online Surveys	Form	New	SimpleReport TouchPoint Survey
252101	[2022, OD] CDC PRIME ReportStream Customer Experience feedback	Form and Instruction	New	Help Improve ReportStream!
252064	"Lyme and other Tickborne Diseases Knowledge, Attitude, and Practice Surveys"	Form and Instruction	New	Survey of NJ Local and County Public Health Agencies Regarding Tick and Tick=borne Disease Managment
252064	"Lyme and other Tickborne Diseases Knowledge, Attitude, and Practice Surveys"	Form	New	A Survey of NJ Mosquito Control Agencies Regarding the Management of Ticks and Tick-borne Disease
251589	OT18-1802: Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation's Health	Form and Instruction	New	Survey Questionnaire
251538	ATSDR Public Health Assessment Basic Course Modernization Focus Group	Other- Facilitators Guide	New
251398	External Partner Focus Groups to Inform Strategic Planning of CDC's Division of Laboratory Systems	Other-02_DLS External Partner Focus Groups 1&2 Guide_01-28-2022	New
250763	2021 CDC Novel Emerging Respiratory Disease [NERD] Academy Surveys [CSELS]	Form and Instruction	New	NERD Academy Webpage Survey (screenshots)
250763	2021 CDC Novel Emerging Respiratory Disease [NERD] Academy Surveys [CSELS]	Form and Instruction	New	NERD Academy Participant Survey (screenshots)
250763	2021 CDC Novel Emerging Respiratory Disease [NERD] Academy Surveys [CSELS]	Other-WORD document to facilitate review of Participant Survey c	New
250532	Centers for Disease Control and Prevention's National Contact Center (CDC-INFO) Web-based Satisfaction Survey	Form and Instruction	New	20211025_CDC-INFO Post Chat Survey V5
250416	Registration and Feedback for the 2021 Place & Health Conference	Form and Instruction	New	Post Event Survey
250416	Registration and Feedback for the 2021 Place & Health Conference	Form and Instruction	New	Registration Form
250323	United States National Authority for the Containment of Polio (NAC) Webinar Survey and Polling Questions	Form	New	U.S. National Authority for the Containment of Polio Webinar Survey
249894	Feedback survey for Oct 2021 webinar (CDC/NIOSH/OD/ORI)	Form and Instruction	New	NIOSH Foresight Friday Webinar
249663	[CSELS DSEPD] CDC Fellowship Recruitment Event Feedback Survey (Nov 2021)	Form and Instruction	New	CDC Fellowship Recruitment Event Feedback Survey
249663	[CSELS DSEPD] CDC Fellowship Recruitment Event Feedback Survey (Nov 2021)	Other-Survey content in WORD format to facilitate review	New
249449	2020 – 2021 CDC Science Ambassador Program Activities Survey	Form and Instruction	New	2020-2021 CDC Science Ambassador Program Activities Survey
249001	ETSB Customer Satisfaction Survey	Form	New	0920-21HQ
248889	Customer Satisfaction with the Division of Global Heath and Tuberculous (DGHT) Science Integrity Branch (SIB) Trainings (2021-2022)	Form and Instruction	New	DGHT SIB Training Assessment Form
248889	Customer Satisfaction with the Division of Global Heath and Tuberculous (DGHT) Science Integrity Branch (SIB) Trainings (2021-2022)	Other-Screen capture of landing page for online version (verifie	New
248866	Feedback Survey for September 2021 Webinar	Form and Instruction	New	Feedback Survey for 2021 Sept Webinar
248687	Clinical Laboratory Partners Forum (CLPF) 2021 Survey	Form and Instruction	New	Clinical Lab Partners Forum Survey 2021
248474	Strategic Scholars Program Participant Feedback Survey	Form and Instruction	New	Strategic Scholars Participant Survey
247229	2021 EIS Virtual Recruitment and Match Customer Service Survey	Form and Instruction	New	2021 EIS Customer Feedback Survey
246943	Epidemiology Elective Program Alumni Survey	Form	New	EEP Alumni Survey - screenshots
246943	Epidemiology Elective Program Alumni Survey	Form	New	EEP Alumni Survey - word
246776	Public Health Improvement Training Attendee Reaction Survey	Form	New	PHIT Survey - mobile
246776	Public Health Improvement Training Attendee Reaction Survey	Form	New	PHIT Survey - web
246776	Public Health Improvement Training Attendee Reaction Survey	Form	New	PHIT Survey - word
246536	Qualitative Feedback on Tools and Resources Provided by DSLR	Form	New	Tools and Resources Survey
246530	Qualitative Feedback on External Training Provided by DSLR	Form	New	Training Feedback
246507	Qualitative Feedback on Preparedness Services Provided through DSLR's On-TRAC	Form	New	On-TRAC Customer Feedback Survey
246278	VetoViolence Tools and Training Usability testing	Form and Instruction	New	Usability Testing Interview Guide - STRYVE
246278	VetoViolence Tools and Training Usability testing	Form and Instruction	New	Usability Testing Interview Guide - Veto Violence
246278	VetoViolence Tools and Training Usability testing	Form and Instruction	New	Follow-Up Email
246278	VetoViolence Tools and Training Usability testing	Form and Instruction	New	Participation Survey
246278	VetoViolence Tools and Training Usability testing	Form and Instruction	New	Invitation Email
246207	National Authority for Containment of Poliovirus Risk Mitigation Strategies Webinar Participant Feedback Polling Questions & Survey	Other-Focus group guide	New
246028	Assessing Perceptions of Operational Planning Workshops to Facilitate Country Planning for Increasing Health Security Capacities	Form and Instruction	New	Operational Planning Workshops Survey
245649	2021 CDC Laboratory Courses for External Audiences Learner Feedback Survey	Form and Instruction	New	2021 CDC Laboratory Training Courses Learner Feedback Survey (External Audiences)
245462	Federal Select Agent Program Feedback Survey (FSAP) Survey	Form	New	FSAP Survey
244975	Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement	Form	New	Post Site Visit Survey
244970	Customer Experience using the PRAMS Integrated Data Collection System	Form and Instruction	New	0920-21BX
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Spring)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Fall)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	CDC Science Ambassador Virtual Training Series Satisfaction Survey (5 surveys)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Spring)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Fall)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	CDC Science Ambassador Virtual Training Series Satisfaction Survey (4 surveys)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Spring)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Fall)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	CDC Science Ambassador Virtual Training Series Satisfaction Survey (3 surveys)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Spring)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Fall)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	CDC Science Ambassador Virtual Training Series Satisfaction Survey (2 surveys)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Training Effectiveness Follow-up (Fall) OR Training Effectiveness Follow-up (Spring)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	CDC Science Ambassador Virtual Training Series Satisfaction Survey (1 survey)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Respondents - No Attendance Session Scheduling (Spring)
244599	CDC Science Ambassador Virtual Training Series Survey	Form and Instruction	New	Respondents - No Attendance Session Scheduling (Fall)
244553	National Authority for Containment of Poliovirus 2020 Poliovirus Containment Webinar Participant Feedback Polling Questions and Survey	Form and Instruction	New	US NAC Webinar Polling Questions
243814	NCIPC Website Usability Testing	Form	New	Screenshots
243814	NCIPC Website Usability Testing	Form	New	Usability Testing Instrument
243166	DELTA Reverse Site Visit Feedback	Form and Instruction	New	2020 Reverse Site Visit Feedback Form
243166	DELTA Reverse Site Visit Feedback	Other-Email	New
243165	Feedback interviews to improve technical assistance	Other-WORD	New
243063	Website Usability Test for Division of Overdose Prevention Websites	Form and Instruction	New	Healthcare Provider - Acute Pain Moderator Guide
243063	Website Usability Test for Division of Overdose Prevention Websites	Form and Instruction	New	Healthcare Provider - Drug Overdose Moderator Guide
243063	Website Usability Test for Division of Overdose Prevention Websites	Form and Instruction	New	Healthcare Provider Screener
243063	Website Usability Test for Division of Overdose Prevention Websites	Form and Instruction	New	Individual - Marijuana Moderator Guide
243063	Website Usability Test for Division of Overdose Prevention Websites	Form and Instruction	New	Individual - Rx Awareness Moderator Guide
243063	Website Usability Test for Division of Overdose Prevention Websites	Form and Instruction	New	Individual Screener
243039	Feedback web-survey on forensic toxicology testing	Form and Instruction	New	Customer Feedback Forensic Toxicology
243039	Feedback web-survey on forensic toxicology testing	Other-Screenshot	New
242695	New Science Ambassador Virtual Training Series Survey	Form and Instruction	New	2020 Science Ambassador Virtual Training Series Satisfaction Survey
242578	WISQARS Data Visualization Mapping Usability Testing Customer Feedback	Form and Instruction	New	Usability_Testing_Discussion_Guide
242578	WISQARS Data Visualization Mapping Usability Testing Customer Feedback	Form and Instruction	New	Participant_Screener
242515	Violence Prevention Technical Assistance Center: Needs Assess	Other-WORD	New
242280	Customer Feedback on CAMP Teen-SPARC Tool Use and Usability	Form and Instruction	New	SPARC Survey
241950	Feedback on the use of the CDC Guideline for Prescribing Opioids for Chronic Pain.	Form and Instruction	New	Online Feedback Opioid Guides
241912	Evaluators' Network, Member Survey	Form	New	2020 Annual Evaluators' Network Member Survey
241912	Evaluators' Network, Member Survey	Instruction	New
241897	OCIO Customer Satisfaction Survey 2020	Form	New	Customer Satisfaction Survey 2020
241850	2020 EIS Virtual Recruitment and Match Customer Service Survey	Form and Instruction	New	2020 EIS Virtual Recruitment and Match Customer Service Survey
241598	Assessing Perceptions of Operational Planning Workshops to Facilitate Country Planning for Increasing Health Security Capacities	Instruction	New
241346	Customer Feedback for Raising Healthy Boys	Form	New	Participant Screening Form
241346	Customer Feedback for Raising Healthy Boys	Other-WORD	New
241329	CDC Laboratory Courses for External Audiences Learner Feedback Survey	Form and Instruction	New	2020 CDC Laboratory Courses for External Audiences Learner Feedback Survey
240802	Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain	Form and Instruction	New	Stakehold Engagement
240546	2020 Science Ambassador Application Survey	Form and Instruction	New	2020 Science Ambassador Application Survey
240546	2020 Science Ambassador Application Survey	Other-WORD (Screenshots)	New
240503	Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain	Instruction	New
240490	Pilot Survey of the Applying CDC's Guidelines for Prescribing Opioids Online Training and Updated Post Course Evaluation	Form and Instruction	New	0920-20LD
240124	Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain	Other-WORD	New
240004	Raising Healthy Boys: Communications Toolkit	Other-WORD	New
239964	2020 Science Ambassador Regional Training Workshops Satisfaction Survey	Form and Instruction	New	2020 Science Ambassador Regional Training Workshop Satisfaction Survey
239612	WISQARS Data Visualization Usability Testing Customer Feedback	Form and Instruction	New	WISQARS User Survey
239565	Dating Matters Customer Satisfaction Survey	Form and Instruction	New	Remote Interview Guide
239565	Dating Matters Customer Satisfaction Survey	Form and Instruction	New	Online Survey - Interview Guide
239565	Dating Matters Customer Satisfaction Survey	Instruction	New
239278	Veto Violence Evaluation Y2	Form and Instruction	New	Connection Selector Survey
239278	Veto Violence Evaluation Y2	Form	New	Violence Prevention in Practice
239278	Veto Violence Evaluation Y2	Other-WORD	New
239208	Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement	Form and Instruction	New	Peer Reviewers Evaluation Form
238726	CDC Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey	Form and Instruction	New	920-20DJ
238459	CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey	Form and Instruction	New	CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey
238101	Fundamentals of Working Safely in a Biological Safety Cabinet, Fundamentals of Chemical Fume Hood Safety, and Fundamentals of Centrifuge Safety CDC eLearning Courses Learner Feedback Survey	Form and Instruction	New	BSC / CFH / Centrifuge Learner Survey
237782	CDC Packaging and Shipping Division 6.2 Materials eLearning Course Learner Feedback Survey	Form and Instruction	New	Customer Survey
237522	CDC Microbiology-Oriented eLearning Courses Learner Feedback Survey	Form	New	eLearning Course Feedback Survey
237144	CDC Import Permit Program (IPP) Inspection Feedback Survey	Form and Instruction	New	CDC Import Permit Program (IPP) Inspection Feedback Survey
237123	CDC-INFO IVR Satisfaction Survey (for Individual Respondents Who Inquire by Phone)	Form and Instruction	New	Interactive Voice Response Survey (Spanish language)
237123	CDC-INFO IVR Satisfaction Survey (for Individual Respondents Who Inquire by Phone)	Form and Instruction	New	Interactive Voice Response Survey (English language)
236806	CDC INFO Email Survey [ALT title: CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)]	Form and Instruction	New	Survey (Spanish)
236806	CDC INFO Email Survey [ALT title: CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)]	Form and Instruction	New	Survey (English language)
236805	CDC-INFO IVR Satisfaction Survey (for Private Sector Respondents Who Inquire by Phone)	Form and Instruction	New	Survey (Spanish language)
236805	CDC-INFO IVR Satisfaction Survey (for Private Sector Respondents Who Inquire by Phone)	Form and Instruction	New	Survey (English language)
236803	CDC-INFO Web-based Satisfaction Survey (for Private Sector Respondents Who Send Email Inquiries)	Form and Instruction	New	Survey (Spanish language)
236803	CDC-INFO Web-based Satisfaction Survey (for Private Sector Respondents Who Send Email Inquiries)	Form and Instruction	New	Survey (English language)
236453	Public Health Improvement Training Reaction Survey	Form and Instruction	New	NNPHI (PHIT End of Training Survey)
236453	Public Health Improvement Training Reaction Survey	Form and Instruction	New	NNPHI (Public Health Improvement Training Reaction Survey)
236453	Public Health Improvement Training Reaction Survey	Other-WORD	New
236431	Assessment of National Public Health Institutes'(NPHI) Capacity to Strengthen Essential Public Health Functions in Countries Supported by U.S. Centers for Disease Control and Prevention	Form and Instruction	New	Interview Protocol - Assessment of NPHI Capacity
236378	Education and Training Services Branch Customer Satisfaction Survey	Form	New	ETSB Customer Satisfaction Survey
236303	Preparedness Field Assignee Alumni Survey	Form and Instruction	New	Preparedness Field Assignee Alumni Survey
236201	Public Health Improvement Training (PHIT) Reaction Survey	Form and Instruction	New	PHIT End of Training Survey - Web version
236201	Public Health Improvement Training (PHIT) Reaction Survey	Form and Instruction	New	PHIT End of Session Survey - Web version
236179	An Assessment of the Feasibility and Sustainability of CDC Zika Activities Funded Under the USAID/CDC Interagency Agreement	Form and Instruction	New	Interview guide exploring crosscutting areas associated with sustainability
236016	App and Web Usability Study for CDC's STD Treatment Guidelines	Form and Instruction	New	User Testing Questions for STD Tx Guide Mobile App and Website

ICR Details

OMB Control No: 0920-1050	ICR Reference No: 201902-0920-022
Status: Historical Active	Previous ICR Reference No: 201605-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1050
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/06/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/21/2019
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2022	36 Months From Approved	06/30/2019
Responses	216,000	0	206,400
Time Burden (Hours)	66,750	0	60,750
Cost Burden (Dollars)	0	0	0

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Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs. Revision request to add respondents and burden.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 12766	03/23/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 10093	03/19/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 99

table that charts list of burden

IC Title	Form No.	Form Name
2021 CDC Novel Emerging Respiratory Disease [NERD] Academy Surveys [CSELS]	n/a, n/a	NERD Academy Participant Survey (screenshots) ,   NERD Academy Webpage Survey (screenshots)
New Science Ambassador Virtual Training Series Survey	0920-20QM	2020 Science Ambassador Virtual Training Series Satisfaction Survey
"Lyme and other Tickborne Diseases Knowledge, Attitude, and Practice Surveys"	0920-1050, 0920-1050	A Survey of NJ Mosquito Control Agencies Regarding the Management of Ticks and Tick-borne Disease ,   Survey of NJ Local and County Public Health Agencies Regarding Tick and Tick=borne Disease Managment
2020 EIS Virtual Recruitment and Match Customer Service Survey	0920-20OI	2020 EIS Virtual Recruitment and Match Customer Service Survey
2020 Science Ambassador Application Survey	0920-1050	2020 Science Ambassador Application Survey
2020 Science Ambassador Regional Training Workshops Satisfaction Survey	0920-20IS	2020 Science Ambassador Regional Training Workshop Satisfaction Survey
2020 – 2021 CDC Science Ambassador Program Activities Survey	0920-21IJ	2020-2021 CDC Science Ambassador Program Activities Survey
2021 CDC Laboratory Courses for External Audiences Learner Feedback Survey	None	2021 CDC Laboratory Training Courses Learner Feedback Survey (External Audiences)
2021 EIS Virtual Recruitment and Match Customer Service Survey	0920-1050	2021 EIS Customer Feedback Survey
2022 EIS Conference and Match Feedback Surveys	0920-1050, 0920-1050	2022 EIS Conference Customer Service Feedback Survey ,   2022 EIS MATCH Customver Service Feedback Survey
2022 EpiEpidemic Intelligence Service (EIS) Conference and Match Feedback Surveys	0920-22EE, 0920-22EE	Att_1_0920-1050_2022_EIS_Conf_Cust_Serv_Fdbk_Survey ,   Att_6_0920-1050_2022_EIS_Match_Cust_Serv_Fdbk_Survey
ATSDR Public Health Assessment Basic Course Modernization Focus Group
An Assessment of the Feasibility and Sustainability of CDC Zika Activities Funded Under the USAID/CDC Interagency Agreement	n/a	Interview guide exploring crosscutting areas associated with sustainability
App and Web Usability Study for CDC's STD Treatment Guidelines	0920-1050	User Testing Questions for STD Tx Guide Mobile App and Website
Assessing Perceptions of Operational Planning Workshops to Facilitate Country Planning for Increasing Health Security Capacities	0920-1050	Operational Planning Workshops Survey
Assessing Perceptions of Operational Planning Workshops to Facilitate Country Planning for Increasing Health Security Capacities
Assessment of National Public Health Institutes'(NPHI) Capacity to Strengthen Essential Public Health Functions in Countries Supported by U.S. Centers for Disease Control and Prevention	N/A	Interview Protocol - Assessment of NPHI Capacity
CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey	n/a	CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey
CDC INFO Email Survey [ALT title: CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)]	n/a, n/a	Survey (English language) ,   Survey (Spanish)
CDC Import Permit Program (IPP) Inspection Feedback Survey	n/a	CDC Import Permit Program (IPP) Inspection Feedback Survey
CDC Laboratory Courses for External Audiences Learner Feedback Survey	0920-1050	2020 CDC Laboratory Courses for External Audiences Learner Feedback Survey
CDC Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey	0920-20DJ	920-20DJ
CDC Microbiology-Oriented eLearning Courses Learner Feedback Survey	none	eLearning Course Feedback Survey
CDC Packaging and Shipping Division 6.2 Materials eLearning Course Learner Feedback Survey	0920-1050	Customer Survey
CDC Science Ambassador Virtual Training Series Survey	0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 09201050	Respondents - No Attendance Session Scheduling (Fall) ,   Respondents - No Attendance Session Scheduling (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (1 survey) ,   Training Effectiveness Follow-up (Fall) OR Training Effectiveness Follow-up (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (2 surveys) ,   Training Effectiveness Follow-up (Fall) ,   Training Effectiveness Follow-up (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (3 surveys) ,   Training Effectiveness Follow-up (Fall) ,   Training Effectiveness Follow-up (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (4 surveys) ,   Training Effectiveness Follow-up (Fall) ,   Training Effectiveness Follow-up (Spring) ,   CDC Science Ambassador Virtual Training Series Satisfaction Survey (5 surveys) ,   Training Effectiveness Follow-up (Fall) ,   Training Effectiveness Follow-up (Spring)
CDC-INFO IVR Satisfaction Survey (for Individual Respondents Who Inquire by Phone)	n/a, n/a	Interactive Voice Response Survey (English language) ,   Interactive Voice Response Survey (Spanish language)
CDC-INFO IVR Satisfaction Survey (for Private Sector Respondents Who Inquire by Phone)	n/a, n/a	Survey (English language) ,   Survey (Spanish language)
CDC-INFO Interactive Voice Response (IVR) Satisfaction Survey (for Individual Respondents Who Inquirer by Phone)	0920-1050	IVR Survey (Individual)
CDC-INFO Interactive Voice Response (IVR) Satisfaction Survey (for Private Respondents Who Inquirer by Phone)	0920-1050	IVR Survey (Private)
CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)	0920-1050	Email Survey Questionnaire
CDC-INFO Web-based Satisfaction Survey (for Private Respondents Who Send Email Inquiries)	0920-1050	Email Survey Questionnaire
CDC-INFO Web-based Satisfaction Survey (for Private Sector Respondents Who Send Email Inquiries)	n/a, n/a	Survey (English language) ,   Survey (Spanish language)
Centers for Disease Control and Prevention's National Contact Center (CDC-INFO) Web-based Satisfaction Survey	0920-22AZ	20211025_CDC-INFO Post Chat Survey V5
Clinical Laboratory Partners Forum (CLPF) 2021 Survey	n/a	Clinical Lab Partners Forum Survey 2021
Customer Experience using the PRAMS Integrated Data Collection System	PIDS User Feedback	0920-21BX
Customer Feedback for Raising Healthy Boys	0920-1050	Participant Screening Form
Customer Feedback on CAMP Teen-SPARC Tool Use and Usability	0920-1050	SPARC Survey
Customer Satisfaction with the Division of Global Heath and Tuberculous (DGHT) Science Integrity Branch (SIB) Trainings (2021-2022)	n/a	DGHT SIB Training Assessment Form
DELTA Reverse Site Visit Feedback	0920-1050	2020 Reverse Site Visit Feedback Form
DSAT Webinar, Webcast, and Workshop Survey	0920-1050	Webinar Webcast Workshop Survey
DSEPD Fellowship Webinar Customer Service Feedback Survey	0920-1050	DSEPD Fellowship Webinar Customer Service Feedback Survey
DSLR Tools and Resources Survey	0920-1050	Tools or Resource Survey
DSLR Training Survey	0920-1050	PIB Training Survey
Dating Matters Customer Satisfaction Survey	0920-1050, 0920-1050	Online Survey - Interview Guide ,   Remote Interview Guide
Dating Matters Rebranding Research	0920-1050	Dating Matters Rebranding Research
ETSB Customer Satisfaction Survey	ETSB_2021_Cust_Sat_ Survey	0920-21HQ
Education and Training Services Branch Customer Satisfaction Survey	none	ETSB Customer Satisfaction Survey
Epidemiology Elective Program Alumni Survey	none, none	EEP Alumni Survey - word ,   EEP Alumni Survey - screenshots
Evaluation of Spanish Webpages (CDC/DHDD)	0920-22DN	Evaluation of the DHDD Spanish Websites Communication Materials
Evaluators' Network, Member Survey	0920-1050	2020 Annual Evaluators' Network Member Survey
Evaluators' Network, Member Survey	0920-1050	Network Member Survey
External Partner Discussion Groups to Inform Strategic Planning of CDC's Division of Laboratory Systems	0920-22EV	DLS External Partner Discussion Group 1-7
External Partner Focus Groups to Inform Strategic Planning of CDC's Division of Laboratory Systems
Federal Select Agent Program Feedback Survey (FSAP) Survey	0920-21CR	FSAP Survey
Feedback Survey for September 2021 Webinar	0920-1050	Feedback Survey for 2021 Sept Webinar
Feedback interviews to improve technical assistance
Feedback on the use of the CDC Guideline for Prescribing Opioids for Chronic Pain.	0920-20OP	Online Feedback Opioid Guides
Feedback survey for Oct 2021 webinar (CDC/NIOSH/OD/ORI)	0920-22AF	NIOSH Foresight Friday Webinar
Feedback web-survey on forensic toxicology testing	0920-1050	Customer Feedback Forensic Toxicology
Fundamentals of Working Safely in a Biological Safety Cabinet, Fundamentals of Chemical Fume Hood Safety, and Fundamentals of Centrifuge Safety CDC eLearning Courses Learner Feedback Survey	0920-1050	BSC / CFH / Centrifuge Learner Survey
IPP and FSAP Inspection Survey	0920-1050	Federal Select Agent Program (FSAP) and Import Permit Program (IPP) Inspection Survey
NCIPC Website Usability Testing	none, none	Usability Testing Instrument ,   Screenshots
National Authority for Containment of Poliovirus 2020 Poliovirus Containment Webinar Participant Feedback Polling Questions and Survey	0920-21BA	US NAC Webinar Polling Questions
National Authority for Containment of Poliovirus Risk Mitigation Strategies Webinar Participant Feedback Polling Questions & Survey
National Center for Injury Prevention and Control (NCIPC) Fellows & Interns' Evaluation	0920-22EK	Att. A NCIPC Fellowship and Internship Evaluation Feedback V3.4.18.22
OCIO Customer Satisfaction Survey 2020	none	Customer Satisfaction Survey 2020
OT18-1802: Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation's Health	0920-1050	Survey Questionnaire
On-TAC Customer Service Survey	0920-22EU	Att1-On-TRAC Survey
Pilot Survey of the Applying CDC's Guidelines for Prescribing Opioids Online Training and Updated Post Course Evaluation	3 Month Follow up Survey	0920-20LD
Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement	0920-1050	Post Site Visit Survey
Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement	0920-1050	NAC Post-site Visit Survey
Preparedness Field Assignee Alumni Survey	0920-1050	Preparedness Field Assignee Alumni Survey
Public Health Improvement Training (PHIT) Reaction Survey	0920-1050, 0920-1050	PHIT End of Session Survey - Web version ,   PHIT End of Training Survey - Web version
Public Health Improvement Training Attendee Reaction Survey	none, none, none	PHIT Survey - word ,   PHIT Survey - web ,   PHIT Survey - mobile
Public Health Improvement Training Attendee Reaction Survey	0920-1050, 0920-1050, 0920-1050	Survey - word ,   Survey - web ,   Survey - mobile
Public Health Improvement Training Reaction Survey	0920-1050, 0920-1050	NNPHI (Public Health Improvement Training Reaction Survey) ,   NNPHI (PHIT End of Training Survey)
Qualitative Feedback on External Training Provided by DSLR	none	Training Feedback
Qualitative Feedback on Preparedness Services Provided through DSLR's On-TRAC	0920-1050	On-TRAC Customer Feedback Survey
Qualitative Feedback on Tools and Resources Provided by DSLR	none	Tools and Resources Survey
Raising Healthy Boys: Communications Toolkit
Registration and Feedback for the 2021 Place & Health Conference	0920-1050, 0920-1050	Registration Form ,   Post Event Survey
SimpleReport Online Surveys	0920-1050	SimpleReport TouchPoint Survey
Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement	0920-1050	Peer Reviewers Evaluation Form
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain	none	Stakehold Engagement
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain
Strategic Scholars Program Participant Feedback Survey	0920-0879	Strategic Scholars Participant Survey
United States National Authority for the Containment of Polio (NAC) Webinar Survey and Polling Questions	0920-1050	Webinar Polling Questions
United States National Authority for the Containment of Polio (NAC) Webinar Survey and Polling Questions	0920-1050	U.S. National Authority for the Containment of Polio Webinar Survey
Veto Violence Evaluation Y2	0920-1050, 0920-1050	Violence Prevention in Practice ,   Connection Selector Survey
VetoViolence Tools and Training Usability testing	0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050	Invitation Email ,   Participation Survey ,   Follow-Up Email ,   Usability Testing Interview Guide - Veto Violence ,   Usability Testing Interview Guide - STRYVE
Violence Prevention Technical Assistance Center: Needs Assess
WISQARS Data Visualization Mapping Usability Testing Customer Feedback	0920-20QB, 0920-20QB	Participant_Screener ,   Usability_Testing_Discussion_Guide
WISQARS Data Visualization Usability Testing Customer Feedback	n/a	WISQARS User Survey
Website Usability Test for Division of Overdose Prevention Websites	0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050	Individual Screener ,   Individual - Rx Awareness Moderator Guide ,   Individual - Marijuana Moderator Guide ,   Healthcare Provider Screener ,   Healthcare Provider - Drug Overdose Moderator Guide ,   Healthcare Provider - Acute Pain Moderator Guide
[2022, OD] CDC PRIME ReportStream Customer Experience feedback	None	Help Improve ReportStream!
[2022] Select Adapt Evaluate - VetoViolence Usability Testing	None, None, None, None	Recruitment Materials ,   Screening Form ,   Interview Scheduling ,   Consent and Interview Guide
[2022] VetoViolence Training and Resource Development - Health Equity	None, None, None, None	Interview Recruitment Materials ,   Interview Consent and Interview Guide ,   Survey Recruitment Materials ,   Survey Consent and Questionnaire
[CSELS DSEPD] CDC Fellowship Recruitment Event Feedback Survey (Nov 2021)	n/a	CDC Fellowship Recruitment Event Feedback Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	216,000	206,400	0	9,600	0	0
Annual Time Burden (Hours)	66,750	60,750	0	6,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden increase due to anticipation of consolidating other Agency Service Delivery clearances into this generic collection.

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Annual Cost to Federal Government: $55,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/21/2019

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