Information Collection

COVID-19 Attitudes and Beliefs Survey (CABS)

IC 245275 under ICR 202112-0990-006 · OMB 0990-0475.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment A COVID-19 Attitudes and Beliefs Survey (CABS)	Form and Instruction
ASPA_OutcomeEval_AQ_Wave2_V2_clean.docx	Other-CABS survey-Wave2
ASPA_OutcomeEval_AQ_Wave2_V2_clean.docx	Other-CABS survey-Wave2
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 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 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
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

IC Title:

COVID-19 Attitudes and Beliefs Survey (CABS)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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) â 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 â 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 â Communications	Part A_Attachment C_COVID-19 Attitudes and Beliefs Survey_Communications.docx	Yes	Yes	Fillable Fileable
Other-CABS survey-Wave2			ASPA_OutcomeEval_AQ_Wave2_V2_clean.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 %

table that charts list of burden
	Approved	Previously Approved
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

table that charts IC Documents
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.