COVID-19 Attitudes and Beliefs Survey (CABS)

ASPA COVID-19 Public Education Campaign Evaluation Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0475 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment A COVID-19 Attitudes and Beliefs Survey (CABS) Form and Instruction
Attachment A Attachment A: COVID-19 Attitudes and Beliefs Survey (CAB Part A_Attachment A_COVID-19 Attitudes and Beliefs_Questionnaire.docx Form and Instruction
Attachment B Attachment B: COVID-19 Attitudes and Beliefs Survey – NO Part A_Attachment B_COVID-19 Attitudes and Beliefs Survey_NORC Consent Form.docx Form and Instruction
Attachment C Attachment C: COVID-19 Attitudes and Beliefs Survey – Co Part A_Attachment C_COVID-19 Attitudes and Beliefs Survey_Communications.docx Form and Instruction

Information Collection (IC) Details

IC Title:	COVID-19 Attitudes and Beliefs Survey (CABS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment A	Attachment A: COVID-19 Attitudes and Beliefs Survey (CABS) – Questionnaire	Part A_Attachment A_COVID-19 Attitudes and Beliefs_Questionnaire.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment B	Attachment B: COVID-19 Attitudes and Beliefs Survey – NORC Consent Form	Part A_Attachment B_COVID-19 Attitudes and Beliefs Survey_NORC Consent Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment C	Attachment C: COVID-19 Attitudes and Beliefs Survey – Communications	Part A_Attachment C_COVID-19 Attitudes and Beliefs Survey_Communications.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	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	12,000	12,000
Annual IC Time Burden (Hours)	6,960	6,960
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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