(genIC) Feedback Survey for Community Counts Data Viz Tool

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Att1_(genIC) Screenshots of CC Data Viz Feedback Survey 9 3 2020.docx Other-Screenshots
(genIC)_Request for Approval CC Data Viz 9 3 2020 (1).docx Request for Approval IC Document
(genIC) Community Counts Data Viz SSA 9 3 2020.docx SSA IC Document
(genIC) Community Counts Data Viz SSB 9 3 2020.docx SSB IC Document
genIC_IRB Determination CC Data Viz 9 3 2020 (1).pdf IRB Determination IC Document

Information Collection (IC) Details

IC Title:	(genIC) Feedback Survey for Community Counts Data Viz Tool	Agency IC Tracking Number:	0920-1154-20RS

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-Screenshots			Att1_(genIC) Screenshots of CC Data Viz Feedback Survey 9 3 2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	(genIC)_Request for Approval CC Data Viz 9 3 2020 (1).docx	09/17/2020
SSA	(genIC) Community Counts Data Viz SSA 9 3 2020.docx	09/17/2020
SSB	(genIC) Community Counts Data Viz SSB 9 3 2020.docx	09/17/2020
IRB Determination	genIC_IRB Determination CC Data Viz 9 3 2020 (1).pdf	09/17/2020

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