Online Survey Instrument

CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis and Nontuberculous Mycobacteria Drug Susceptibility Testing

Documents and Forms

Document Name Document Type
Form 0920-0600 Online Survey Instrument Form
0920-0600 Att. 8-Survey Instrument Webshots Att. 8-Survey Instrument Webshots.pdf Form
0920-0600 Att. 8-Survey Instrument Webshots Att. 8-Survey Instrument Webshots.pdf Form
Survey Instrument Changes.docx Survey Instrument Changes IC Document
Survey Instrument Changes.docx Survey Instrument Changes IC Document

Information Collection (IC) Details

IC Title:	Online Survey Instrument	Agency IC Tracking Number:	0920-0600

Is this a Common Form? No		IC Status: Modified

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
Form	0920-0600	Att. 8-Survey Instrument Webshots	Att. 8-Survey Instrument Webshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	160	0	160
Annual IC Time Burden (Hours)	40	0	40
Annual IC Cost Burden (Dollars)	0	-1,478	1,478

Documents for IC

Title	Document	Date Uploaded
Survey Instrument Changes	Survey Instrument Changes.docx	11/07/2013

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