Information Collection

[CSTLTS] Disease Intervention Specialist (DIS) Workforce Assessment

IC 258835 under ICR 202011-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0879 Disease Intervention Professional Enumeration Study (Local) [CSTLTS] Disease Intervention Specialist (DIS) Workforce Assessment	Form and Instruction
Form 0920-0879 Disease Intervention Professional Enumeration Study (State & Territorial) [CSTLTS] Disease Intervention Specialist (DIS) Workforce Assessment	Form and Instruction
0920-0879 Disease Intervention Professional Enumeration Study (Loc Attachment E- Instrument Local Web Version.pdf	Form and Instruction
0920-0879 Disease Intervention Professional Enumeration Study (Sta Attachment C- Instrument State and Territorial Web Version.pdf	Form and Instruction
DIS Enumeration SSA.docx Supporting Statement A	IC Document
DIS Enumeration SSB.docx Supporting Statement B	IC Document
Attachment A- State, Territorial, and Local Health Departments.docx Att A_State, Territorial, and Local Health Departments	IC Document
Attachment B- Instrument State and Territorial Word Version.docx Att B_Instrument State and Territorial Word Version	IC Document
Attachment D- Instrument Local Word Version.docx Att D_Instrument Local Word Version	IC Document
Attachment F- State and Territorial Notification Email.docx Att F_State and Territorial Notification Email	IC Document
Attachment G- State and Territorial Reminder Email.docx Att G_State and Territorial Reminder Email	IC Document
Attachment H- State and Territorial Extension Email.docx Att G_State and Territorial Extension Email	IC Document
Attachment I- Local Notification Email.docx Att I_ Local Notification Email	IC Document
Attachment J- Local Reminder Email.docx Att J_Local Reminder Email	IC Document
Attachment K- Local Extension Email.docx Att K_ Local Extension Email	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[CSTLTS] Disease Intervention Specialist (DIS) Workforce Assessment

Agency IC Tracking Number:

0920-0879-23CX

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
Form and Instruction	0920-0879				Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 491

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	491	491
Annual IC Time Burden (Hours)	985	985
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A		03/01/2023
Supporting Statement B		03/01/2023
Att A_State, Territorial, and Local Health Departments		03/03/2023
Att B_Instrument State and Territorial Word Version		03/03/2023
Att D_Instrument Local Word Version		03/03/2023
Att F_State and Territorial Notification Email		03/03/2023
Att G_State and Territorial Reminder Email		03/03/2023
Att G_State and Territorial Extension Email		03/03/2023
Att I_ Local Notification Email		03/03/2023
Att J_Local Reminder Email		03/03/2023
Att K_ Local Extension Email		03/03/2023

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

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