Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CSP Feedback Questionnaire	Form and Instruction	New	Repair queued
Form 0920-25-0011 2025 CDC-INFO Email Survey SPANISH	Form	New	Repair queued
Form 0920-25-0011 2025 CDC-INFO Email Survey ENGLISH	Form	New	Repair queued
Form 0920-25-0053 Post-site Survey	Form	New	Repair queued
Form 0920-1050 Tools for Overdose Prevention Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Recruitment Letter	Form and Instruction	New	Repair queued
Form 25-0009 2025 CDC-INFO IVR Survey SPANISH	Form	New	Repair queued
Form 25-0009 2025 CDC-INFO IVR Survey ENGLISH	Form	New	Repair queued
Form 0920-1050 National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) Survey	Form and Instruction	New	Repair queued
Form 0920-1050 CDC Biosafety ECHO Surveys_Compiled Demographic, Post Session, Follow-Up	Form and Instruction	New	Repair queued
Form 0920-25CS WAI Learning Community Survey	Form	New	Repair queued
WAI Technical Assistance Follow-up Survey	Form and Instruction	New	Repair queued
WAI Mentorship Survey	Form and Instruction	New	Repair queued
Form 0920-1050 WAI - RETENTION SURVEY	Form and Instruction	New	Repair queued
Form 0920-1050 (25CE) 2025 CDC Division of Workforce Development (DWD) Fellowship Webinar Customer Service Feedback Survey	Form and Instruction	New	Repair queued
Form 0920-25BW CDC eICR Data Project - Discussion Guide	Form	New	Repair queued
Form 0920-1050 Education and Training Needs Assessment – Survey Questions _2024	Form and Instruction	New	Repair queued
Form 0920-25BH ECHO Survey	Form	New	Repair queued
Form 0920-1050 Workforce Acceleration Initiative (WAI) Public Health Agency Narrative Reports (24AS)	Form and Instruction	New	Repair queued
Form 0920-25AK ADPHA Survey	Form	New	Repair queued
Verint Foresee Survey Questions	Form and Instruction	New	Repair queued
Form 0920-1050 DEIA Mentorship Program Pre Program	Form and Instruction	New	Repair queued
Form 0920-1050 DEIA Mentorship Program Post Program	Form and Instruction	New	Repair queued
Form 0929-1050 Consent Form - Spanish	Form and Instruction	New	Repair queued
Form 0929-1050 Focus Group Guide - Spanish	Form and Instruction	New	Repair queued
Form 0929-1050 Recruitment Screener - Spanish	Form and Instruction	New	Repair queued
Form 0929-1050 Consent Form - English	Form and Instruction	New	Repair queued
Form 0929-1050 Focus Group Guide - English	Form and Instruction	New	Repair queued
Form 0929-1050 Recruitment Screener - English	Form and Instruction	New	Repair queued
Form 0920-1050 CDC Threat Agnostic Program - Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Guiding Questions for the PHHS Block Grant and PHIG Listening Session	Form and Instruction	New	Repair queued
Form 0920-1050 Series Feedback Form	Form and Instruction	New	Repair queued
Form 0920-1050 Session Feedback Form	Form and Instruction	New	Repair queued
Form 0920-24HF Feedback Survey	Form	New	Repair queued
Form 0920-1050 Participant Trainings Survey	Form and Instruction	New	Repair queued
Post Session Feedback Form	Form and Instruction	New	Repair queued
Form 0920-1050 Individual TA Feedback	Form and Instruction	New	Repair queued
Form 0920-1050 Group TA Feedback	Form and Instruction	New	Repair queued
Form 0920-1050 Discussions for Improving Case Data Entry Workflows	Form and Instruction	New	Repair queued
Form 0920-1050 CDC USABILITY AND DIGITAL CONTENT TESTING Content Feedback-A/B Comparison-Design Feedback-Data Visualization Tests	Form and Instruction	New	Repair queued
Form 0920-1050 eCR Viewer (DIBBs) Online Survey via Touchpoints	Form	New	Repair queued
Form 0920-1050 Recruitment Screener	Form and Instruction	New	Repair queued
Form 0920-1050 Post-Study Interview	Form and Instruction	New	Repair queued
Form 0920-1050 Weeks 4-5 Task Questions	Form and Instruction	New	Repair queued
Form 0920-1050 Weeks 2-3 Task Questions	Form and Instruction	New	Repair queued
Form 0920-1050 Week 1 Task Questions	Form and Instruction	New	Repair queued
Form 0920-1050 Pre-Study Meeting	Form and Instruction	New	Repair queued
Form 0920-24FX SOR Engagement Survey	Form	New	Repair queued
Post Site Visit Survey	Form and Instruction	New	Repair queued
2024 Evaluator Network Survey	Form and Instruction	New	Repair queued
Form 0920-1050 ReportStream Usability Survey	Form and Instruction	New	Repair queued
Form 0920-24EW Virtual Post-Event Survey	Form	New	Repair queued
Form 0920-24EW In-Person Post-Event Survey	Form	New	Repair queued
LTF Tour/Visit Evaluation Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Post-Event Survey for Virtual Attendees	Form and Instruction	New	Repair queued
Form 0920-1050 Post-Event Survey for In-Person Attendees	Form and Instruction	New	Repair queued
Form 0920-1050 2024 Clinical Laboratory Partners Forum Survey (24EN)	Form	New	Repair queued
Form 0920-1050 NBS User Training Material Preference Survey	Form and Instruction	New	Repair queued
Form 0920-1050-2ED eFSAP Survey	Form and Instruction	New	Repair queued
2024 EIS Match Customer Service Feedback Survey	Form and Instruction	New	Repair queued
2024 EIS Conference Customer Service Feedback Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Annual IPP Survey (External Users)	Form and Instruction	New	Repair queued
Form 0920-1050-24DX 2024 Science Ambassador Regional Training Workshop Satisfaction Survey	Form	New	Repair queued
Talking about Naloxone survey	Form and Instruction	New	Repair queued
Form 0920-1050 Focus Group - Subject matter experts in populations	Form and Instruction	New	Repair queued
Form 0920-1050 Survey - Subject matter experts in populations	Form and Instruction	New	Repair queued
Form 0920-1050 Focus Group - Jurisdictional public health staff members	Form and Instruction	New	Repair queued
Form 0920-1050 Survey - Jurisdictional public health staff members	Form and Instruction	New	Repair queued
Form 0920-1050-24DG 0920-1050 NBS User Feedback Survey_Att A	Form and Instruction	New	Repair queued
Personal Interview Guide	Form and Instruction	New	Repair queued
Focus Group Interview Guide	Form and Instruction	New	Repair queued
Personal Interview Guide	Form and Instruction	New	Repair queued
Focus Group Interview Guide	Form and Instruction	New	Repair queued
Form 0920-1050 CDC Flu Usability Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Homeless Management Information System (HMIS) and Immunization Information System (IIS) Data Sharing/Data Partnership Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Shiriki Protocol New Member_Webinar Feedback Form	Form and Instruction	New	Repair queued
Form 0920-1050 DWD Fellowship Webinar Customer Service Feedback Survey	Form and Instruction	New	Repair queued
Form 0920-1050 2024 ECHO Survey - Demographic/Session/Follow-Up	Form and Instruction	New	Repair queued
Form 0920-1050 Semi-Structured Discussion Guides - Improving Services of Vaccination Rate Tracking	Form and Instruction	New	Repair queued
Form 0920-1050 APHL-CDC Fellowship/Internship/Genomic Data Internship Survey	Form and Instruction	New	Repair queued
Focus Group Interview Outline	Form and Instruction	New	Repair queued
Introduction to Laboratory Safety for Non-Laboratory Staff	Form and Instruction	New	Repair queued
Fundamentals of Laboratory Safety for Short-Term Visitors	Form and Instruction	New	Repair queued
Form 0920-1050 RVR Data Dashboard cdc.gov feedback survey	Form and Instruction	New	Repair queued
Form 0920-24AF TA Feedback Survey Instrument_0920-1050 GenIC	Form and Instruction	New	Repair queued
Form 0920-1050 2023 OneLab Summit Feedback	Form and Instruction	New	Repair queued
Survey and Invitation	Form and Instruction	New	Repair queued
Form 0920-23HN Att1- PHEM ELP Training Feedback	Form and Instruction	New	Repair queued
Form 0920-23HO Att1_PH_LEADS_2023_0920-1050surveyword	Form and Instruction	New	Repair queued
Form 0920-1050 Recipient Follow Up Form for Individual TA	Form and Instruction	New	Repair queued
Form 0920-1050 Recipient Feedback Form for Individual TA	Form and Instruction	New	Repair queued
Form 0920-1050 Participant Feedback Form for Peer Learning Communities	Form and Instruction	New	Repair queued
Form 0920-1050 Participant Feedback Form for Group Learning Events	Form and Instruction	New	Repair queued
Form 0920-23HI 02_CLPF Meeting Evaluation Survey_2023.09.25 in Qualtrics	Form and Instruction	New	Repair queued
Survey Instrument CDC PRC Program Team	Form and Instruction	New	Repair queued
Survey Instrument CDC Team	Form and Instruction	New	Repair queued
Form 0920-1050 Clinical Practice Guideline Outreach and Communication Materials Feedback	Form and Instruction	New	Repair queued
Form 0920-23GW Interview Guide	Form and Instruction	New	Repair queued
Form 0920-1050 VetoViolence Training Satisfaction Survey and Informed Consent	Form and Instruction	New	Repair queued
Form 0920-1050-23GI USCS _GOV SECTOR	Form and Instruction	New	Repair queued
Form 0920-23GI Customer Service GenIC Clearance_USCS-DataViz_Private-Sector_Attachment-1	Form and Instruction	New	Repair queued
Form 0920-1050-23GH Att 1_Epi Info User Survey_Final	Form and Instruction	New	Repair queued
Form 0920-1050 Cancer Screening Change Package Evaluation Survey	Form and Instruction	New	Repair queued
Form 0920-23GD Attachment A - SSP Instrument Word Version	Form and Instruction	New	Repair queued
Form 0920-1050 2023 CDC Science Ambassador Fellowship Exit Survey	Form and Instruction	New	Repair queued
CDC Science Ambassador Fellowship Summer Course Satisfaction Survey	Form and Instruction	New	Repair queued
Form 0920-1050 DMI Evaluation Survey	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Pilot Live Chat Customer Satisfaction Survey - Page 2	Form and Instruction	New	Repair queued
Form 0920-1050 2023 CDC-INFO Pilot Live Chat Customer Satisfaction Survey	Form and Instruction	New	Repair queued
Form 0920-1050 2023 CDC-INFO Pilot Chatbot Customer Satisfaction Survey	Form and Instruction	New	Repair queued
Form 0920-1050 SimpleReport Website_Web Application Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Family Health Profiles	Form	New	Repair queued
Form 0920-1050 My Family Health Portrait:Cancer Mobile Application Evaluation Question	Form and Instruction	New	Repair queued
Universal Engagement Panel Screener	Form and Instruction	New	Repair queued
Form 0920-1050 DSLR Tools and Resources Survey	Form and Instruction	New	Repair queued
Form 0920-23EJ AttachD_Instrument4_Post-Event Survey for Virtual Attendees_PHIT2023	Form and Instruction	New	Repair queued
Form 0920-23EJ AttachC_Instrument3_Post-Event Survey for In-Person Attendees_PHIT2023	Form and Instruction	New	Repair queued
Form 0920-23EJ AttachB_Instrument2_Special Session Survey _PHIT2023	Form and Instruction	New	Repair queued
Form 0920-23EJ AttachA_Instrument1_Skill-Building Workshop Survey _PHIT2023	Form and Instruction	New	Repair queued
Form 0920-1050 CDC 1815/1817 Recipient Satisfaction Survey	Form and Instruction	New	Repair queued
2023 Annual Evaluators' Network Member Survey	Form and Instruction	New	Repair queued
Form 0920-1050 DSLR Participant Trainings Survey	Form and Instruction	New	Repair queued
Form 0920-1050 On-TRAC Customer Feedback Survey	Form and Instruction	New	Repair queued
Post-Event Survey for Virtual Attendees	Form and Instruction	New	Repair queued
Post-Event Survey for In-Person Attendees	Form and Instruction	New	Repair queued
Special Session Survey	Form and Instruction	New	Repair queued
Skill-Building Workshop Survey	Form and Instruction	New	Repair queued
Post-Event Survey for Virtual Attendees	Form and Instruction	New	Repair queued
Post-Event Survey for In-Person Attendees	Form and Instruction	New	Repair queued
Special Session Survey	Form and Instruction	New	Repair queued
Skill-Building Workshop Survey	Form and Instruction	New	Repair queued
ELI Mentor End of Year Survey	Form and Instruction	New	Repair queued
ELI Fellow End of Year Survey	Form and Instruction	New	Repair queued
2023 EIS Match Customer Service Feedback Survey	Form and Instruction	New	Repair queued
2023 EIS Conference Customer Service Feedback Survey	Form and Instruction	New	Repair queued
Form 0920-1050 2023 CDC DWD Fellowship Webinar Customer Service Feedback Survey Screenshots	Form and Instruction	New	Repair queued
Form 0920-1050 DOH TA Satisfaction Survey	Form and Instruction	New	Repair queued
Question Pool for CDC Foundation	Form and Instruction	New	Repair queued
Form 0920-23CE Att 1_0920-1050_2023_Sci_Amb_Rgnl_Training_Wkshp_Cust_Sat_Survey_subm	Form and Instruction	New	Repair queued
Post-Program Interview Discussion Guide	Form and Instruction	New	Repair queued
Post-Program Assessment Instrument	Form and Instruction	New	Repair queued
In-Person Session Assessment Instrument	Form and Instruction	New	Repair queued
In-Person Post-Session Assessment Instrument	Form and Instruction	New	Repair queued
Orientation Assessment Instrument	Form and Instruction	New	Repair queued
Form 0920-1050 Customer Feedback Survey about the Electronic Federal Select Agent Program (eFSAP)	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Telephone Service Customer Satisfaction Survey - Spanish	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Telephone Service Customer Satisfaction Survey - English	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Email Service - Customer Satisfaction Survey - Spanish	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Email Service - Customer Satisfaction Survey - English	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Email Service - Customer Satisfaction Survey - Spanish	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Email Service - Customer Satisfaction Survey - English	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Telephone Service Customer Satisfaction Survey - Spanish	Form and Instruction	New	Repair queued
Form 0920-1050 CDC-INFO Telephone Service Customer Satisfaction Survey - English	Form and Instruction	New	Repair queued
Interview Protocol for Opioid Rapid Response Patient Absorption Interviews	Form and Instruction	New	Repair queued
CLPF Meeting Evaluation Survey	Form and Instruction	New	Repair queued
1) Registration Survey; 2) Post-Session Survey Questions; 3) CDC Biosafety ECHO Follow-up Surveys	Form and Instruction	New	Repair queued
Form 0920-1050 Usability Testing / Digital Content Testing Form (Moderated/Unmoderated)	Form and Instruction	New	Repair queued
Form 0920-1050 American Indian, Alaska Native, Native Hawaiian Career Expo Post Event Survey	Form and Instruction	New	Repair queued
Form 0920-23AE CDC VDAT HD Customer Satisfaction Survey	Form and Instruction	New	Repair queued
Form 0920-1050 American Indian, Alaska Native, Native Hawaiian Career Expo Post-Event Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Screener & Geotagging Beta Survey	Form	New	Repair queued
Form 0920-1050 Focus Group to Improve the Surveillance Data Lifecycle	Form and Instruction	New	Repair queued
2023 CDC Epidemic Intelligence Service Candidate Feedback Survey (screen shots)	Form and Instruction	New	Repair queued
Form 0920-1050 Strategic Scholars Program End-of -Cohort Survery	Form and Instruction	New	Repair queued
Form 0920-1050 Usability Testing Script for CCSM CDS Interface	Form and Instruction	New	Repair queued
Form 0920-1050 Customer Satisfaction Survey	Form and Instruction	New	Repair queued
Form 0920-1050 Participant Screener (English Groups)	Form and Instruction	New	Repair queued
Form 0920-1050 2022 ECHO Registration and Post-Session Survey Questions	Form and Instruction	New	Repair queued
Form 0920-1050 Training Assessment Form	Form and Instruction	New	Repair queued
Form 0920-1050-22HB Att1-eIPPSurvey	Form and Instruction	New	Repair queued
Form 0920-1050 User Experience Survey	Form and Instruction	New	Available
Form 0920-1050 DMI Evaluation Survey_2022	Form and Instruction	New	Repair queued
Customer Service GenIC Clearance Template.docx	Supplementary Document	Uploaded 2022-05-13	Repair queued
60 Day FRN.pdf	Supplementary Document	Uploaded 2022-05-13	Repair queued
SSB fast track_final.docx	Supporting Statement B	Uploaded 2022-05-13	Repair queued
SSA fast track_final.docx	Supporting Statement A	Uploaded 2022-05-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
274497	[NCIPC] Comprehensive Suicide Prevention (CSP) Evaluation Learning Network Questionnaire	Form and Instruction	New	CSP Feedback Questionnaire
274472	[OADC] CDC-INFO Web-based Satisfaction Survey	Form	New	2025 CDC-INFO Email Survey SPANISH
274472	[OADC] CDC-INFO Web-based Satisfaction Survey	Form	New	2025 CDC-INFO Email Survey ENGLISH
274471	[CPR]NAC Post-visit Survey	Form	New	Post-site Survey
274300	Translating Evidence to Practice Implementation Tools for Preventing Overdose	Form and Instruction	New	Tools for Overdose Prevention Survey
274300	Translating Evidence to Practice Implementation Tools for Preventing Overdose	Form and Instruction	New	Recruitment Letter
274019	[OACD] CDC-INFO IVR Survey - Individual	Form	New	2025 CDC-INFO IVR Survey SPANISH
274019	[OACD] CDC-INFO IVR Survey - Individual	Form	New	2025 CDC-INFO IVR Survey ENGLISH
274012	[OPHDST] National Syndromic Surveillance (NSSP) Community of Practice (CoP) Survey	Form and Instruction	New	National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) Survey
273804	[OLSS] Project ECHO Biosafety Community of Practice: Demographic and Follow-up Surveys	Form and Instruction	New	CDC Biosafety ECHO Surveys_Compiled Demographic, Post Session, Follow-Up
273678	[OPHDST] WAI Learning Community Survey	Form	New	WAI Learning Community Survey
273651	[OPHDST] Workforce Acceleration Initiative (WAI) Technical Assistance Follow-up Survey	Form and Instruction	New	WAI Technical Assistance Follow-up Survey
273650	[OPHDST] Workforce Acceleration Initiative (WAI) Mentorship Survey	Form and Instruction	New	WAI Mentorship Survey
273641	[OPHDST] Workforce Acceleration Initiative (WAI) Retention Survey	Form and Instruction	New	WAI - RETENTION SURVEY
273195	2025 CDC Division of Workforce Development (DWD) Fellowship Webinar Customer Service Feedback Survey	Form and Instruction	New	2025 CDC Division of Workforce Development (DWD) Fellowship Webinar Customer Service Feedback Survey
273195	2025 CDC Division of Workforce Development (DWD) Fellowship Webinar Customer Service Feedback Survey	Instruction	New
273059	[OPHDST] eICR Data Project	Form	New	CDC eICR Data Project - Discussion Guide
272443	Survey for Soliciting Feedback on National Healthcare Safety Network Education and Training Assessment	Form and Instruction	New	Education and Training Needs Assessment – Survey Questions _2024
272437	[OLSS] Project ECHO Biosafety Community of Practice: Registration and Follow-up Surveys	Form	New	ECHO Survey
272207	[OPHDST] MVPS CaseBridge	Instruction	New
271864	[OPHDST] Workforce Acceleration Initiative (WAI) Public Health Agency Narrative Reports	Form and Instruction	New	Workforce Acceleration Initiative (WAI) Public Health Agency Narrative Reports (24AS)
271851	[OPHDST] Advancing Data for Public Health Action Partner Survey	Form	New	ADPHA Survey
271837	[OADC] CDC Digital Content Customer Satisfaction Survey	Form and Instruction	New	Verint Foresee Survey Questions
271360	[NCIRD] DEIA Mentorship Program	Form and Instruction	New	DEIA Mentorship Program Pre Program
271360	[NCIRD] DEIA Mentorship Program	Form and Instruction	New	DEIA Mentorship Program Post Program
271299	[NCIPC] Essentials for Parenting Toddlers Customer Service Feedback	Form and Instruction	New	Consent Form - Spanish
271299	[NCIPC] Essentials for Parenting Toddlers Customer Service Feedback	Form and Instruction	New	Focus Group Guide - Spanish
271299	[NCIPC] Essentials for Parenting Toddlers Customer Service Feedback	Form and Instruction	New	Recruitment Screener - Spanish
271299	[NCIPC] Essentials for Parenting Toddlers Customer Service Feedback	Form and Instruction	New	Consent Form - English
271299	[NCIPC] Essentials for Parenting Toddlers Customer Service Feedback	Form and Instruction	New	Focus Group Guide - English
271299	[NCIPC] Essentials for Parenting Toddlers Customer Service Feedback	Form and Instruction	New	Recruitment Screener - English
270903	[ORR] CDC Threat Agnostic Program Engagement Form	Form and Instruction	New	CDC Threat Agnostic Program - Survey
270197	[PHIC] PHHS Block Grant and PHIG Listening Sessions (2024)	Form and Instruction	New	Guiding Questions for the PHHS Block Grant and PHIG Listening Session
269310	[NCEZID] 2024 Infection Prevention and Control Webinar Training Series - Post Event (Series) Feedback	Form and Instruction	New	Series Feedback Form
269304	[NCEZID] 2024 Infection Prevention and Control Webinar Training Series - Post Event (Session) Feedback	Form and Instruction	New	Session Feedback Form
269271	[PHIC] Strategic Scholars Program Feedback Survey 2024	Form	New	Feedback Survey
269086	[ORR] DSLR Training Survey	Form and Instruction	New	Participant Trainings Survey
268859	[GHC] Frontline Healthcare Workforce Strengthening Project	Form and Instruction	New	Post Session Feedback Form
268688	[NCIPC] Core State Injury Prevention Program (Core SIPP)	Form and Instruction	New	Individual TA Feedback
268688	[NCIPC] Core State Injury Prevention Program (Core SIPP)	Form and Instruction	New	Group TA Feedback
268661	[OPHDST] Discussions for Improving Case Data Entry Workflows	Form and Instruction	New	Discussions for Improving Case Data Entry Workflows
268266	CDC Usability and Digital Content Testing	Form and Instruction	New	CDC USABILITY AND DIGITAL CONTENT TESTING Content Feedback-A/B Comparison-Design Feedback-Data Visualization Tests
268247	[OPHDST] : eCR Viewer Data Integration Building Blocks (DIBBs) Online Survey	Form	New	eCR Viewer (DIBBs) Online Survey via Touchpoints
268072	My Family Health Portrait Usability Study	Form and Instruction	New	Recruitment Screener
268072	My Family Health Portrait Usability Study	Form and Instruction	New	Post-Study Interview
268072	My Family Health Portrait Usability Study	Form and Instruction	New	Weeks 4-5 Task Questions
268072	My Family Health Portrait Usability Study	Form and Instruction	New	Weeks 2-3 Task Questions
268072	My Family Health Portrait Usability Study	Form and Instruction	New	Week 1 Task Questions
268072	My Family Health Portrait Usability Study	Form and Instruction	New	Pre-Study Meeting
268058	[CPR] NAC Statement of Responsibility (SOR) Survey	Form	New	SOR Engagement Survey
267912	[CPR] Post Visit Survey for Facility Evaluation of US National Authority for Containment of Poliovirus (NAC) Performance and Improvement	Form and Instruction	New	Post Site Visit Survey
267516	[NCCDPHP] 2024 Evaluators' Network, Member Survey	Form and Instruction	New	2024 Evaluator Network Survey
267240	[OPHDST] ReportStream Usability Survey	Form and Instruction	New	ReportStream Usability Survey
267200	[PHIC] 2024 Public Health Improvement Training (PHIT) Reaction Surveys - STLT Attendees	Form	New	Virtual Post-Event Survey
267200	[PHIC] 2024 Public Health Improvement Training (PHIT) Reaction Surveys - STLT Attendees	Form	New	In-Person Post-Event Survey
267061	[OLSS] Laboratory Training Facility (LTF): Tours/Visits	Form and Instruction	New	LTF Tour/Visit Evaluation Survey
267041	[PHIC] 2024 Public Health Improvement Training (PHIT) Reaction Surveys – Private Sector Attendees	Form and Instruction	New	Post-Event Survey for Virtual Attendees
267041	[PHIC] 2024 Public Health Improvement Training (PHIT) Reaction Surveys – Private Sector Attendees	Form and Instruction	New	Post-Event Survey for In-Person Attendees
266722	Clinical Laboratory Partners Forum Meeting Evaluation Survey 2024	Form	New	2024 Clinical Laboratory Partners Forum Survey (24EN)
266719	[OPHDST] National Electronic Disease Surveillance System Base System User Training Material Preference Survey	Form and Instruction	New	NBS User Training Material Preference Survey
266515	Case Service Design: A Day in the Life Qualitative Study	Other-Invitation	New
266360	[CPR] eFSAP information System Survey	Form and Instruction	New	eFSAP Survey
266334	[PHIC] 2024 Epidemic Intelligence Service (EIS) Conference and Match Customer Service Feedback Surveys	Form and Instruction	New	2024 EIS Match Customer Service Feedback Survey
266334	[PHIC] 2024 Epidemic Intelligence Service (EIS) Conference and Match Customer Service Feedback Surveys	Form and Instruction	New	2024 EIS Conference Customer Service Feedback Survey
266322	[CPR] Annual Import Permit Program Survey (genIC)	Form and Instruction	New	Annual IPP Survey (External Users)
266284	[PHIC] 2024 Science Ambassador Regional Training Workshop Satisfaction Survey	Form	New	2024 Science Ambassador Regional Training Workshop Satisfaction Survey
266188	[NCIPC] Three-Month Survey: Module WB4518, Talking about Naloxone	Form and Instruction	New	Talking about Naloxone survey
266180	[OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction	New	Focus Group - Subject matter experts in populations
266180	[OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction	New	Survey - Subject matter experts in populations
266180	[OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction	New	Focus Group - Jurisdictional public health staff members
266180	[OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction	New	Survey - Jurisdictional public health staff members
265909	[CSELS] GenIC, "NBS Page Builder Demo User Feedback Survey	Form and Instruction	New	0920-1050 NBS User Feedback Survey_Att A
265901	[NCCDPHP] User Feedback – U.S. Cancer Statistics Public Use Databases – State Health Department	Form and Instruction	New	Personal Interview Guide
265901	[NCCDPHP] User Feedback – U.S. Cancer Statistics Public Use Databases – State Health Department	Form and Instruction	New	Focus Group Interview Guide
265844	[NCCDPHP] User Feedback – U.S. Cancer Statistics Public Use Databases – Private Sector	Form and Instruction	New	Personal Interview Guide
265844	[NCCDPHP] User Feedback – U.S. Cancer Statistics Public Use Databases – Private Sector	Form and Instruction	New	Focus Group Interview Guide
265638	[OADC] CDC Flu Usability Testing	Form and Instruction	New	CDC Flu Usability Survey
264918	[OPHDST] HMIS and IIS Integration Survey to Improve Vaccination Rate Tracking among People Experiencing Homelessness (PEH)	Form and Instruction	New	Homeless Management Information System (HMIS) and Immunization Information System (IIS) Data Sharing/Data Partnership Survey
264659	[CGH] Shiriki Virtual Community Annual Planning Survey	Form and Instruction	New	Shiriki Protocol New Member_Webinar Feedback Form
264082	[PHIC] 2024 CDC Division of Workforce Development (DWD) Fellowship Webinar Customer Service Feedback Survey	Form and Instruction	New	DWD Fellowship Webinar Customer Service Feedback Survey
263827	[CLSR/DLS] Project ECHO Biosafety Community of Practice Demographic and Follow-up Surveys	Form and Instruction	New	2024 ECHO Survey - Demographic/Session/Follow-Up
263683	Improving Services of Vaccination Rate Tracking among People Experiencing Homelessness (PEH)	Form and Instruction	New	Semi-Structured Discussion Guides - Improving Services of Vaccination Rate Tracking
263380	[CSELS_DSL] APHL-CDC Career Pathways in Public Health Laboratory Science Program Surveys	Form and Instruction	New	APHL-CDC Fellowship/Internship/Genomic Data Internship Survey
263293	[OPHDST] Focus Groups to Provide Feedback on the FY 2024 Public Health Data Strategy Goals and Milestones	Form and Instruction	New	Focus Group Interview Outline
263292	[OLSS] CDC Laboratory Courses for External Audiences Learner Feedback Survey	Form and Instruction	New	Introduction to Laboratory Safety for Non-Laboratory Staff
263292	[OLSS] CDC Laboratory Courses for External Audiences Learner Feedback Survey	Form and Instruction	New	Fundamentals of Laboratory Safety for Short-Term Visitors
263182	[OPHDST] Respiratory Virus Response (RVR) Website Content Feedback Survey	Form and Instruction	New	RVR Data Dashboard cdc.gov feedback survey
262908	[NCCDPHP] Prevention Research Centers (PRC) Program Technical Assistance Feedback Survey	Form and Instruction	New	TA Feedback Survey Instrument_0920-1050 GenIC
261894	[CSELS] CLSRDLS CDC OneLab Summit Evaluation	Form and Instruction	New	2023 OneLab Summit Feedback
261558	[OS] User Experience Survey to Understand What's Working and What Can be Improved with National Electronic Disease Surveillance System (NEDSS) Base System (NBS)	Form and Instruction	New	Survey and Invitation
261495	[CPR]ORR - Public Health Emergency Management (PHEM) Emerging Leadership Program (ELP) Training Feedback	Form and Instruction	New	Att1- PHEM ELP Training Feedback
261494	[CSELS] [PHIC] PH LEADS Post-training Evaluation (2023)	Form and Instruction	New	Att1_PH_LEADS_2023_0920-1050surveyword
261488	[NCIPC] Violence Prevention Technical Assistance Center Participant Feedback Forms	Form and Instruction	New	Recipient Follow Up Form for Individual TA
261488	[NCIPC] Violence Prevention Technical Assistance Center Participant Feedback Forms	Form and Instruction	New	Recipient Feedback Form for Individual TA
261488	[NCIPC] Violence Prevention Technical Assistance Center Participant Feedback Forms	Form and Instruction	New	Participant Feedback Form for Peer Learning Communities
261488	[NCIPC] Violence Prevention Technical Assistance Center Participant Feedback Forms	Form and Instruction	New	Participant Feedback Form for Group Learning Events
261484	[CSELS] CLSR/DLS CLPF Meeting Evaluation Survey 2023	Form and Instruction	New	02_CLPF Meeting Evaluation Survey_2023.09.25 in Qualtrics
261459	[NCCDPHP] Prevention Research Centers (PRC) Program Technical Assistance Feedback Survey	Form and Instruction	New	Survey Instrument CDC PRC Program Team
261459	[NCCDPHP] Prevention Research Centers (PRC) Program Technical Assistance Feedback Survey	Form and Instruction	New	Survey Instrument CDC Team
261299	Clinical Practice Guideline Outreach and Communication Materials Feedback	Form and Instruction	New	Clinical Practice Guideline Outreach and Communication Materials Feedback
261202	[CGH] ADDIE Model Analysis	Form and Instruction	New	Interview Guide
261146	[NCIPC] VetoViolence Training Satisfaction Survey	Form and Instruction	New	VetoViolence Training Satisfaction Survey and Informed Consent
261137	[NCCDPHP] US Cancer Statistics Data Visualizations Tool -Government Sector	Form and Instruction	New	USCS _GOV SECTOR
260962	[NCCDPHP] USCS Data Visualizations Tool- Private Sector	Form and Instruction	New	Customer Service GenIC Clearance_USCS-DataViz_Private-Sector_Attachment-1
260961	[CSELS] Epi Info User Survey	Form and Instruction	New	Att 1_Epi Info User Survey_Final
260719	[NCCDPHP] Cancer Screening Change Package Evaluation	Form and Instruction	New	Cancer Screening Change Package Evaluation Survey
260675	[CSLS] Strategic Scholars Program Participant Feedback Survey	Form and Instruction	New	Attachment A - SSP Instrument Word Version
260639	[CSELS] 2023 CDC Science Ambassador Fellowship Exit Survey	Form and Instruction	New	2023 CDC Science Ambassador Fellowship Exit Survey
260639	[CSELS] 2023 CDC Science Ambassador Fellowship Exit Survey	Other-WORD	New
260637	[CSELS] Science Ambassador Fellowship (SAF) Summer Course Satisfaction Survey (2023)	Form and Instruction	New	CDC Science Ambassador Fellowship Summer Course Satisfaction Survey
260637	[CSELS] Science Ambassador Fellowship (SAF) Summer Course Satisfaction Survey (2023)	Other-WORD document to facilitate content review of SAF Survey	New
260636	[OS] DMI Evaluation Survey for soliciting feedback on the Data Modernization Initiative Learning Community (DMI LC)	Form and Instruction	New	DMI Evaluation Survey
260604	CDC-INFO Web-based Satisfaction Survey for the Chatbot Tool & People Using Live Chat Service	Form and Instruction	New	CDC-INFO Pilot Live Chat Customer Satisfaction Survey - Page 2
260604	CDC-INFO Web-based Satisfaction Survey for the Chatbot Tool & People Using Live Chat Service	Form and Instruction	New	2023 CDC-INFO Pilot Live Chat Customer Satisfaction Survey
260604	CDC-INFO Web-based Satisfaction Survey for the Chatbot Tool & People Using Live Chat Service	Form and Instruction	New	2023 CDC-INFO Pilot Chatbot Customer Satisfaction Survey
260603	[OS] SimpleReport Touchpoint Surveys v2	Form and Instruction	New	SimpleReport Website_Web Application Survey
260592	[NCCDPHP] My Family Health Portrait Cancer mobile application	Form	New	Family Health Profiles
260592	[NCCDPHP] My Family Health Portrait Cancer mobile application	Other-WORD	New
260350	My Family Health Portrait Cancer mobile application	Form and Instruction	New	My Family Health Portrait:Cancer Mobile Application Evaluation Question
260201	[OD] Focus Groups to Identify Customers' Pain Points and Opportunities in Collecting, Managing, and Using Data – to Inform the Design of Building Blocks	Form and Instruction	New	Universal Engagement Panel Screener
260149	[ORR] DSLR Tools and Resources Survey	Form and Instruction	New	DSLR Tools and Resources Survey
260073	[CSTLTS] 2023 Public Health Improvement Training Reaction Surveys – Private Sector Attendees	Form and Instruction	New	AttachD_Instrument4_Post-Event Survey for Virtual Attendees_PHIT2023
260073	[CSTLTS] 2023 Public Health Improvement Training Reaction Surveys – Private Sector Attendees	Form and Instruction	New	AttachC_Instrument3_Post-Event Survey for In-Person Attendees_PHIT2023
260073	[CSTLTS] 2023 Public Health Improvement Training Reaction Surveys – Private Sector Attendees	Form and Instruction	New	AttachB_Instrument2_Special Session Survey _PHIT2023
260073	[CSTLTS] 2023 Public Health Improvement Training Reaction Surveys – Private Sector Attendees	Form and Instruction	New	AttachA_Instrument1_Skill-Building Workshop Survey _PHIT2023
260065	[OADC] CDC DDT Recipient Satisfaction Survey	Form and Instruction	New	CDC 1815/1817 Recipient Satisfaction Survey
260004	[NCCDPHP] 2023 Annual Evaluators' Network Member Survey	Form and Instruction	New	2023 Annual Evaluators' Network Member Survey
259991	[ORR] DSLR Training Survey	Form and Instruction	New	DSLR Participant Trainings Survey
259990	[ORR] OnTrac Survey	Form and Instruction	New	On-TRAC Customer Feedback Survey
259798	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - Private Sector Attendees	Form and Instruction	New	Post-Event Survey for Virtual Attendees
259798	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - Private Sector Attendees	Form and Instruction	New	Post-Event Survey for In-Person Attendees
259798	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - Private Sector Attendees	Form and Instruction	New	Special Session Survey
259798	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - Private Sector Attendees	Form and Instruction	New	Skill-Building Workshop Survey
259798	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - Private Sector Attendees	Other-Screenshot of Survey Access from Event Home Screen and Cen	New
259752	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - STLT Attendees	Form and Instruction	New	Post-Event Survey for Virtual Attendees
259752	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - STLT Attendees	Form and Instruction	New	Post-Event Survey for In-Person Attendees
259752	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - STLT Attendees	Form and Instruction	New	Special Session Survey
259752	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - STLT Attendees	Form and Instruction	New	Skill-Building Workshop Survey
259752	[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - STLT Attendees	Other-Screenshot of Survey Access from Event Home Screen and Cen	New
259744	[CSELS] ELI Fellowship End of Year Survey	Form and Instruction	New	ELI Mentor End of Year Survey
259744	[CSELS] ELI Fellowship End of Year Survey	Form and Instruction	New	ELI Fellow End of Year Survey
259677	2023 Epidemic Intelligence Service (EIS) Conference and Match Feedback Surveys	Form and Instruction	New	2023 EIS Match Customer Service Feedback Survey
259677	2023 Epidemic Intelligence Service (EIS) Conference and Match Feedback Surveys	Form and Instruction	New	2023 EIS Conference Customer Service Feedback Survey
259253	[CSELS] 2023 CDC DWD Fellowship Webinar Customer Feedback Survey	Form and Instruction	New	2023 CDC DWD Fellowship Webinar Customer Service Feedback Survey Screenshots
259253	[CSELS] 2023 CDC DWD Fellowship Webinar Customer Feedback Survey	Other-WORD	New
258442	[OS NCCDPHP] Award Management Platform Customer Satisfaction Surveys-Division of Oral Health	Form and Instruction	New	DOH TA Satisfaction Survey
258374	Identifying customers' pain points and opportunities to collect, manage, and use data to inform the design of shared services between CDC and state, territorial, and local ph authoriities	Form and Instruction	New	Question Pool for CDC Foundation
258374	Identifying customers' pain points and opportunities to collect, manage, and use data to inform the design of shared services between CDC and state, territorial, and local ph authoriities	Instruction	New
258023	[CSELS] Science Ambassador Regional Training Workshop	Form and Instruction	New	Att 1_0920-1050_2023_Sci_Amb_Rgnl_Training_Wkshp_Cust_Sat_Survey_subm
257953	[OADPS] Feedback on Innovation Hub Training (2023)	Form and Instruction	New	Post-Program Interview Discussion Guide
257953	[OADPS] Feedback on Innovation Hub Training (2023)	Form and Instruction	New	Post-Program Assessment Instrument
257953	[OADPS] Feedback on Innovation Hub Training (2023)	Form and Instruction	New	In-Person Session Assessment Instrument
257953	[OADPS] Feedback on Innovation Hub Training (2023)	Form and Instruction	New	In-Person Post-Session Assessment Instrument
257953	[OADPS] Feedback on Innovation Hub Training (2023)	Form and Instruction	New	Orientation Assessment Instrument
257921	Electronic Federal Select Agent Program (eFSAP) Information System Survey	Form and Instruction	New	Customer Feedback Survey about the Electronic Federal Select Agent Program (eFSAP)
256932	[OD] CDC-INFO IVR Customer Satisfaction Survey - Individual Respondent - Phone	Form and Instruction	New	CDC-INFO Telephone Service Customer Satisfaction Survey - Spanish
256932	[OD] CDC-INFO IVR Customer Satisfaction Survey - Individual Respondent - Phone	Form and Instruction	New	CDC-INFO Telephone Service Customer Satisfaction Survey - English
256931	[OD] CDC-INFO Web-based Customer Satisfaction Survey - Private Sector - Email	Form and Instruction	New	CDC-INFO Email Service - Customer Satisfaction Survey - Spanish
256931	[OD] CDC-INFO Web-based Customer Satisfaction Survey - Private Sector - Email	Form and Instruction	New	CDC-INFO Email Service - Customer Satisfaction Survey - English
256930	[OD] CDC-INFO Web-based Customer Satisfaction Survey - Individual Respondent - Email	Form and Instruction	New	CDC-INFO Email Service - Customer Satisfaction Survey - Spanish
256930	[OD] CDC-INFO Web-based Customer Satisfaction Survey - Individual Respondent - Email	Form and Instruction	New	CDC-INFO Email Service - Customer Satisfaction Survey - English
256929	[OD] CDC-INFO IVR Customer Satisfaction Survey - Private Sector - Phone	Form and Instruction	New	CDC-INFO Telephone Service Customer Satisfaction Survey - Spanish
256929	[OD] CDC-INFO IVR Customer Satisfaction Survey - Private Sector - Phone	Form and Instruction	New	CDC-INFO Telephone Service Customer Satisfaction Survey - English
256874	[NCIPC] Special Emphasis Panel (SEP) Peer Review Evaluation	Other-WORD	New
256844	[NCIPC] Opioid Rapid Response Patient Absorption Interviews	Form and Instruction	New	Interview Protocol for Opioid Rapid Response Patient Absorption Interviews
256766	Clinical Laboratory Partners Forum Meeting Evaluation Survey 2022	Form and Instruction	New	CLPF Meeting Evaluation Survey
256765	[OADC] CDC Taxonomy Testing	Other-WORD	New
256754	[CSELS] Project ECHO Biosafety Community of Practice: Registration and Follow-up Surveys (2022-2023)	Form and Instruction	New	1) Registration Survey; 2) Post-Session Survey Questions; 3) CDC Biosafety ECHO Follow-up Surveys
256748	[OADC] 2022 CDC Usability Testing and Digital Content Testing	Form and Instruction	New	Usability Testing / Digital Content Testing Form (Moderated/Unmoderated)
256500	American Indian, Alaska Native, Native Hawaiian Career Expo Post-Event Survey	Form and Instruction	New	American Indian, Alaska Native, Native Hawaiian Career Expo Post Event Survey
256484	Centers for Disease Control and Prevention (CDC) Vaccine Distribution and Administration Tracking (VDAT) Help Desk (HD) Customer Satisfaction (CSAT) Survey	Form and Instruction	New	CDC VDAT HD Customer Satisfaction Survey
256316	American Indian, Alaska Native, Native Hawaiian Career Expo Post-Event Survey	Form and Instruction	New	American Indian, Alaska Native, Native Hawaiian Career Expo Post-Event Survey
256203	PHDI Geotagging Beta Survey	Form	New	Screener & Geotagging Beta Survey
256129	Focus Groups to identify pain points and opportunities in collecting, managing, and using data to inform the design of Building Blocks	Form and Instruction	New	Focus Group to Improve the Surveillance Data Lifecycle
255932	[CSELS, 2022] 2023 CDC Epidemic Intelligence Service Candidate Feedback Survey	Form and Instruction	New	2023 CDC Epidemic Intelligence Service Candidate Feedback Survey (screen shots)
255872	Strategic Scholars Program Participant Feedback Survey	Form and Instruction	New	Strategic Scholars Program End-of -Cohort Survery
255604	Pilot Evaluation for Cervical Cancer Clinical Decision Support Tools	Form and Instruction	New	Usability Testing Script for CCSM CDS Interface
255489	ETSB Customer Satisfaction Survey	Form and Instruction	New	Customer Satisfaction Survey
255311	My Mobility Product Testing Activities	Form and Instruction	New	Participant Screener (English Groups)
255311	My Mobility Product Testing Activities	Instruction	New
254975	Project ECHO Biosafety Community of Practice: Registration and Follow-up Surveys	Form and Instruction	New	2022 ECHO Registration and Post-Session Survey Questions
254966	Participant Assessment of Science Integrity Branch (SIB) Trainings (2022-2024)	Form and Instruction	New	Training Assessment Form
254563	Electronic Import Permit Program (eIPP) Information System Survey	Form and Instruction	New	Att1-eIPPSurvey
254431	Regulated Entity Technology Survey	Form and Instruction	New	User Experience Survey
254429	Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation's Health CoAg	Form and Instruction	New	DMI Evaluation Survey_2022

ICR Details

OMB Control No: 0920-1050	ICR Reference No: 202204-0920-013
Status: Historical Active	Previous ICR Reference No: 201902-0920-022
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1050
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/28/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/23/2022
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2025	36 Months From Approved	06/30/2022
Responses	216,000	0	216,000
Time Burden (Hours)	66,750	0	66,750
Cost Burden (Dollars)	0	0	0

---

Abstract: This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs. This Extension contains only minor edits.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 8259	02/14/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 29319	05/13/2022
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 127

table that charts list of burden

IC Title	Form No.	Form Name
Participant Assessment of Science Integrity Branch (SIB) Trainings (2022-2024)	0920-1050	Training Assessment Form
American Indian, Alaska Native, Native Hawaiian Career Expo Post-Event Survey	0920-1050	American Indian, Alaska Native, Native Hawaiian Career Expo Post-Event Survey
Pilot Evaluation for Cervical Cancer Clinical Decision Support Tools	0920-1050	Usability Testing Script for CCSM CDS Interface
2023 Epidemic Intelligence Service (EIS) Conference and Match Feedback Surveys	n/a, n/a	2023 EIS Conference Customer Service Feedback Survey ,   2023 EIS Match Customer Service Feedback Survey
2025 CDC Division of Workforce Development (DWD) Fellowship Webinar Customer Service Feedback Survey	0920-1050 (25CE)	2025 CDC Division of Workforce Development (DWD) Fellowship Webinar Customer Service Feedback Survey
American Indian, Alaska Native, Native Hawaiian Career Expo Post-Event Survey	0920-1050	American Indian, Alaska Native, Native Hawaiian Career Expo Post Event Survey
CDC Usability and Digital Content Testing	0920-1050	CDC USABILITY AND DIGITAL CONTENT TESTING Content Feedback-A/B Comparison-Design Feedback-Data Visualization Tests
CDC-INFO Web-based Satisfaction Survey for the Chatbot Tool & People Using Live Chat Service	0920-1050, 0920-1050, 0920-1050	2023 CDC-INFO Pilot Chatbot Customer Satisfaction Survey ,   2023 CDC-INFO Pilot Live Chat Customer Satisfaction Survey ,   CDC-INFO Pilot Live Chat Customer Satisfaction Survey - Page 2
Case Service Design: A Day in the Life Qualitative Study
Centers for Disease Control and Prevention (CDC) Vaccine Distribution and Administration Tracking (VDAT) Help Desk (HD) Customer Satisfaction (CSAT) Survey	0920-23AE	CDC VDAT HD Customer Satisfaction Survey
Clinical Laboratory Partners Forum Meeting Evaluation Survey 2022	n/a	CLPF Meeting Evaluation Survey
Clinical Laboratory Partners Forum Meeting Evaluation Survey 2024	0920-1050	2024 Clinical Laboratory Partners Forum Survey (24EN)
Clinical Practice Guideline Outreach and Communication Materials Feedback	0920-1050	Clinical Practice Guideline Outreach and Communication Materials Feedback
ETSB Customer Satisfaction Survey	0920-1050	Customer Satisfaction Survey
Electronic Federal Select Agent Program (eFSAP) Information System Survey	0920-1050	Customer Feedback Survey about the Electronic Federal Select Agent Program (eFSAP)
Electronic Import Permit Program (eIPP) Information System Survey	0920-1050-22HB	Att1-eIPPSurvey
Focus Groups to identify pain points and opportunities in collecting, managing, and using data to inform the design of Building Blocks	0920-1050	Focus Group to Improve the Surveillance Data Lifecycle
Identifying customers' pain points and opportunities to collect, manage, and use data to inform the design of shared services between CDC and state, territorial, and local ph authoriities	n/a	Question Pool for CDC Foundation
Improving Services of Vaccination Rate Tracking among People Experiencing Homelessness (PEH)	0920-1050	Semi-Structured Discussion Guides - Improving Services of Vaccination Rate Tracking
My Family Health Portrait Cancer mobile application	0920-1050	My Family Health Portrait:Cancer Mobile Application Evaluation Question
My Family Health Portrait Usability Study	0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050, 0920-1050	Pre-Study Meeting ,   Week 1 Task Questions ,   Weeks 2-3 Task Questions ,   Weeks 4-5 Task Questions ,   Post-Study Interview ,   Recruitment Screener
My Mobility Product Testing Activities	0920-1050	Participant Screener (English Groups)
PHDI Geotagging Beta Survey	0920-1050	Screener & Geotagging Beta Survey
Project ECHO Biosafety Community of Practice: Registration and Follow-up Surveys	0920-1050	2022 ECHO Registration and Post-Session Survey Questions
Regulated Entity Technology Survey	0920-1050	User Experience Survey
Strategic Scholars Program Participant Feedback Survey	0920-1050	Strategic Scholars Program End-of -Cohort Survery
Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation's Health CoAg	0920-1050	DMI Evaluation Survey_2022
Survey for Soliciting Feedback on National Healthcare Safety Network Education and Training Assessment	0920-1050	Education and Training Needs Assessment – Survey Questions _2024
Translating Evidence to Practice Implementation Tools for Preventing Overdose	0920-1050, 0920-1050	Recruitment Letter ,   Tools for Overdose Prevention Survey
[CGH] ADDIE Model Analysis	0920-23GW	Interview Guide
[CGH] Shiriki Virtual Community Annual Planning Survey	0920-1050	Shiriki Protocol New Member_Webinar Feedback Form
[CLSR/DLS] Project ECHO Biosafety Community of Practice Demographic and Follow-up Surveys	0920-1050	2024 ECHO Survey - Demographic/Session/Follow-Up
[CPR] Annual Import Permit Program Survey (genIC)	0920-1050	Annual IPP Survey (External Users)
[CPR] NAC Statement of Responsibility (SOR) Survey	0920-24FX	SOR Engagement Survey
[CPR] Post Visit Survey for Facility Evaluation of US National Authority for Containment of Poliovirus (NAC) Performance and Improvement	n/a	Post Site Visit Survey
[CPR] eFSAP information System Survey	0920-1050-2ED	eFSAP Survey
[CPR]NAC Post-visit Survey	0920-25-0053	Post-site Survey
[CPR]ORR - Public Health Emergency Management (PHEM) Emerging Leadership Program (ELP) Training Feedback	0920-23HN	Att1- PHEM ELP Training Feedback
[CSELS, 2022] 2023 CDC Epidemic Intelligence Service Candidate Feedback Survey	None	2023 CDC Epidemic Intelligence Service Candidate Feedback Survey (screen shots)
[CSELS] 2023 CDC DWD Fellowship Webinar Customer Feedback Survey	0920-1050	2023 CDC DWD Fellowship Webinar Customer Service Feedback Survey Screenshots
[CSELS] 2023 CDC Science Ambassador Fellowship Exit Survey	0920-1050	2023 CDC Science Ambassador Fellowship Exit Survey
[CSELS] CLSR/DLS CLPF Meeting Evaluation Survey 2023	0920-23HI	02_CLPF Meeting Evaluation Survey_2023.09.25 in Qualtrics
[CSELS] CLSRDLS CDC OneLab Summit Evaluation	0920-1050	2023 OneLab Summit Feedback
[CSELS] ELI Fellowship End of Year Survey	n/a, n/a	ELI Fellow End of Year Survey ,   ELI Mentor End of Year Survey
[CSELS] Epi Info User Survey	0920-1050-23GH	Att 1_Epi Info User Survey_Final
[CSELS] GenIC, "NBS Page Builder Demo User Feedback Survey	0920-1050-24DG	0920-1050 NBS User Feedback Survey_Att A
[CSELS] Project ECHO Biosafety Community of Practice: Registration and Follow-up Surveys (2022-2023)	None	1) Registration Survey; 2) Post-Session Survey Questions; 3) CDC Biosafety ECHO Follow-up Surveys
[CSELS] Science Ambassador Fellowship (SAF) Summer Course Satisfaction Survey (2023)	None	CDC Science Ambassador Fellowship Summer Course Satisfaction Survey
[CSELS] Science Ambassador Regional Training Workshop	0920-23CE	Att 1_0920-1050_2023_Sci_Amb_Rgnl_Training_Wkshp_Cust_Sat_Survey_subm
[CSELS] [PHIC] PH LEADS Post-training Evaluation (2023)	0920-23HO	Att1_PH_LEADS_2023_0920-1050surveyword
[CSELS_DSL] APHL-CDC Career Pathways in Public Health Laboratory Science Program Surveys	0920-1050	APHL-CDC Fellowship/Internship/Genomic Data Internship Survey
[CSLS] Strategic Scholars Program Participant Feedback Survey	0920-23GD	Attachment A - SSP Instrument Word Version
[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - Private Sector Attendees	None, None, None, None	Skill-Building Workshop Survey ,   Special Session Survey ,   Post-Event Survey for In-Person Attendees ,   Post-Event Survey for Virtual Attendees
[CSTLTS] 2023 Public Health Improvement Training Attendee Reaction Surveys - STLT Attendees	None, None, None, None	Skill-Building Workshop Survey ,   Special Session Survey ,   Post-Event Survey for In-Person Attendees ,   Post-Event Survey for Virtual Attendees
[CSTLTS] 2023 Public Health Improvement Training Reaction Surveys – Private Sector Attendees	0920-23EJ, 0920-23EJ, 0920-23EJ, 0920-23EJ	AttachA_Instrument1_Skill-Building Workshop Survey _PHIT2023 ,   AttachB_Instrument2_Special Session Survey _PHIT2023 ,   AttachC_Instrument3_Post-Event Survey for In-Person Attendees_PHIT2023 ,   AttachD_Instrument4_Post-Event Survey for Virtual Attendees_PHIT2023
[GHC] Frontline Healthcare Workforce Strengthening Project	n/a	Post Session Feedback Form
[NCCDPHP] 2023 Annual Evaluators' Network Member Survey	None	2023 Annual Evaluators' Network Member Survey
[NCCDPHP] 2024 Evaluators' Network, Member Survey	n/a	2024 Evaluator Network Survey
[NCCDPHP] Cancer Screening Change Package Evaluation	0920-1050	Cancer Screening Change Package Evaluation Survey
[NCCDPHP] My Family Health Portrait Cancer mobile application	0920-1050	Family Health Profiles
[NCCDPHP] Prevention Research Centers (PRC) Program Technical Assistance Feedback Survey	0920-24AF	TA Feedback Survey Instrument_0920-1050 GenIC
[NCCDPHP] Prevention Research Centers (PRC) Program Technical Assistance Feedback Survey	n/a, n/a	Survey Instrument CDC Team ,   Survey Instrument CDC PRC Program Team
[NCCDPHP] US Cancer Statistics Data Visualizations Tool -Government Sector	0920-1050-23GI	USCS _GOV SECTOR
[NCCDPHP] USCS Data Visualizations Tool- Private Sector	0920-23GI	Customer Service GenIC Clearance_USCS-DataViz_Private-Sector_Attachment-1
[NCCDPHP] User Feedback – U.S. Cancer Statistics Public Use Databases – Private Sector	n/a, n/a	Focus Group Interview Guide ,   Personal Interview Guide
[NCCDPHP] User Feedback – U.S. Cancer Statistics Public Use Databases – State Health Department	n/a, n/a	Focus Group Interview Guide ,   Personal Interview Guide
[NCEZID] 2024 Infection Prevention and Control Webinar Training Series - Post Event (Series) Feedback	0920-1050	Series Feedback Form
[NCEZID] 2024 Infection Prevention and Control Webinar Training Series - Post Event (Session) Feedback	0920-1050	Session Feedback Form
[NCIPC] Comprehensive Suicide Prevention (CSP) Evaluation Learning Network Questionnaire	n/a	CSP Feedback Questionnaire
[NCIPC] Core State Injury Prevention Program (Core SIPP)	0920-1050, 0920-1050	Group TA Feedback ,   Individual TA Feedback
[NCIPC] Essentials for Parenting Toddlers Customer Service Feedback	0929-1050, 0929-1050, 0929-1050, 0929-1050, 0929-1050, 0929-1050	Recruitment Screener - English ,   Focus Group Guide - English ,   Consent Form - English ,   Recruitment Screener - Spanish ,   Focus Group Guide - Spanish ,   Consent Form - Spanish
[NCIPC] Opioid Rapid Response Patient Absorption Interviews	None	Interview Protocol for Opioid Rapid Response Patient Absorption Interviews
[NCIPC] Special Emphasis Panel (SEP) Peer Review Evaluation
[NCIPC] Three-Month Survey: Module WB4518, Talking about Naloxone	n/a	Talking about Naloxone survey
[NCIPC] VetoViolence Training Satisfaction Survey	0920-1050	VetoViolence Training Satisfaction Survey and Informed Consent
[NCIPC] Violence Prevention Technical Assistance Center Participant Feedback Forms	0920-1050, 0920-1050, 0920-1050, 0920-1050	Participant Feedback Form for Group Learning Events ,   Participant Feedback Form for Peer Learning Communities ,   Recipient Feedback Form for Individual TA ,   Recipient Follow Up Form for Individual TA
[NCIRD] DEIA Mentorship Program	0920-1050, 0920-1050	DEIA Mentorship Program Post Program ,   DEIA Mentorship Program Pre Program
[OACD] CDC-INFO IVR Survey - Individual	25-0009, 25-0009	2025 CDC-INFO IVR Survey ENGLISH ,   2025 CDC-INFO IVR Survey SPANISH
[OADC] 2022 CDC Usability Testing and Digital Content Testing	0920-1050	Usability Testing / Digital Content Testing Form (Moderated/Unmoderated)
[OADC] CDC DDT Recipient Satisfaction Survey	0920-1050	CDC 1815/1817 Recipient Satisfaction Survey
[OADC] CDC Digital Content Customer Satisfaction Survey	n/a	Verint Foresee Survey Questions
[OADC] CDC Flu Usability Testing	0920-1050	CDC Flu Usability Survey
[OADC] CDC Taxonomy Testing
[OADC] CDC-INFO Web-based Satisfaction Survey	0920-25-0011, 0920-25-0011	2025 CDC-INFO Email Survey ENGLISH ,   2025 CDC-INFO Email Survey SPANISH
[OADPS] Feedback on Innovation Hub Training (2023)	None, None, None, None, None	Orientation Assessment Instrument ,   In-Person Post-Session Assessment Instrument ,   In-Person Session Assessment Instrument ,   Post-Program Assessment Instrument ,   Post-Program Interview Discussion Guide
[OD] CDC-INFO IVR Customer Satisfaction Survey - Individual Respondent - Phone	0920-1050, 0920-1050	CDC-INFO Telephone Service Customer Satisfaction Survey - English ,   CDC-INFO Telephone Service Customer Satisfaction Survey - Spanish
[OD] CDC-INFO IVR Customer Satisfaction Survey - Private Sector - Phone	0920-1050, 0920-1050	CDC-INFO Telephone Service Customer Satisfaction Survey - English ,   CDC-INFO Telephone Service Customer Satisfaction Survey - Spanish
[OD] CDC-INFO Web-based Customer Satisfaction Survey - Individual Respondent - Email	0920-1050, 0920-1050	CDC-INFO Email Service - Customer Satisfaction Survey - English ,   CDC-INFO Email Service - Customer Satisfaction Survey - Spanish
[OD] CDC-INFO Web-based Customer Satisfaction Survey - Private Sector - Email	0920-1050, 0920-1050	CDC-INFO Email Service - Customer Satisfaction Survey - English ,   CDC-INFO Email Service - Customer Satisfaction Survey - Spanish
[OD] Focus Groups to Identify Customers' Pain Points and Opportunities in Collecting, Managing, and Using Data – to Inform the Design of Building Blocks	n/a	Universal Engagement Panel Screener
[OLSS] CDC Laboratory Courses for External Audiences Learner Feedback Survey	n/a, n/a	Fundamentals of Laboratory Safety for Short-Term Visitors ,   Introduction to Laboratory Safety for Non-Laboratory Staff
[OLSS] Laboratory Training Facility (LTF): Tours/Visits	n/a	LTF Tour/Visit Evaluation Survey
[OLSS] Project ECHO Biosafety Community of Practice: Demographic and Follow-up Surveys	0920-1050	CDC Biosafety ECHO Surveys_Compiled Demographic, Post Session, Follow-Up
[OLSS] Project ECHO Biosafety Community of Practice: Registration and Follow-up Surveys	0920-25BH	ECHO Survey
[OPHDST] : eCR Viewer Data Integration Building Blocks (DIBBs) Online Survey	0920-1050	eCR Viewer (DIBBs) Online Survey via Touchpoints
[OPHDST] Advancing Data for Public Health Action Partner Survey	0920-25AK	ADPHA Survey
[OPHDST] Discussions for Improving Case Data Entry Workflows	0920-1050	Discussions for Improving Case Data Entry Workflows
[OPHDST] Focus Groups to Provide Feedback on the FY 2024 Public Health Data Strategy Goals and Milestones	n/a	Focus Group Interview Outline
[OPHDST] HMIS and IIS Integration Survey to Improve Vaccination Rate Tracking among People Experiencing Homelessness (PEH)	0920-1050	Homeless Management Information System (HMIS) and Immunization Information System (IIS) Data Sharing/Data Partnership Survey
[OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	0920-1050, 0920-1050, 0920-1050, 0920-1050	Survey - Jurisdictional public health staff members ,   Focus Group - Jurisdictional public health staff members ,   Survey - Subject matter experts in populations ,   Focus Group - Subject matter experts in populations
[OPHDST] MVPS CaseBridge
[OPHDST] National Electronic Disease Surveillance System Base System User Training Material Preference Survey	0920-1050	NBS User Training Material Preference Survey
[OPHDST] National Syndromic Surveillance (NSSP) Community of Practice (CoP) Survey	0920-1050	National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) Survey
[OPHDST] ReportStream Usability Survey	0920-1050	ReportStream Usability Survey
[OPHDST] Respiratory Virus Response (RVR) Website Content Feedback Survey	0920-1050	RVR Data Dashboard cdc.gov feedback survey
[OPHDST] WAI Learning Community Survey	0920-25CS	WAI Learning Community Survey
[OPHDST] Workforce Acceleration Initiative (WAI) Mentorship Survey	n/a	WAI Mentorship Survey
[OPHDST] Workforce Acceleration Initiative (WAI) Public Health Agency Narrative Reports	0920-1050	Workforce Acceleration Initiative (WAI) Public Health Agency Narrative Reports (24AS)
[OPHDST] Workforce Acceleration Initiative (WAI) Retention Survey	0920-1050	WAI - RETENTION SURVEY
[OPHDST] Workforce Acceleration Initiative (WAI) Technical Assistance Follow-up Survey	n/a	WAI Technical Assistance Follow-up Survey
[OPHDST] eICR Data Project	0920-25BW	CDC eICR Data Project - Discussion Guide
[ORR] DSLR Tools and Resources Survey	0920-1050	DSLR Tools and Resources Survey
[ORR] CDC Threat Agnostic Program Engagement Form	0920-1050	CDC Threat Agnostic Program - Survey
[ORR] DSLR Training Survey	0920-1050	Participant Trainings Survey
[ORR] DSLR Training Survey	0920-1050	DSLR Participant Trainings Survey
[ORR] OnTrac Survey	0920-1050	On-TRAC Customer Feedback Survey
[OS NCCDPHP] Award Management Platform Customer Satisfaction Surveys-Division of Oral Health	0920-1050	DOH TA Satisfaction Survey
[OS] DMI Evaluation Survey for soliciting feedback on the Data Modernization Initiative Learning Community (DMI LC)	0920-1050	DMI Evaluation Survey
[OS] SimpleReport Touchpoint Surveys v2	0920-1050	SimpleReport Website_Web Application Survey
[OS] User Experience Survey to Understand What's Working and What Can be Improved with National Electronic Disease Surveillance System (NEDSS) Base System (NBS)	n/a	Survey and Invitation
[PHIC] 2024 CDC Division of Workforce Development (DWD) Fellowship Webinar Customer Service Feedback Survey	0920-1050	DWD Fellowship Webinar Customer Service Feedback Survey
[PHIC] 2024 Epidemic Intelligence Service (EIS) Conference and Match Customer Service Feedback Surveys	n/a, n/a	2024 EIS Conference Customer Service Feedback Survey ,   2024 EIS Match Customer Service Feedback Survey
[PHIC] 2024 Public Health Improvement Training (PHIT) Reaction Surveys - STLT Attendees	0920-24EW, 0920-24EW	In-Person Post-Event Survey ,   Virtual Post-Event Survey
[PHIC] 2024 Public Health Improvement Training (PHIT) Reaction Surveys – Private Sector Attendees	0920-1050, 0920-1050	Post-Event Survey for In-Person Attendees ,   Post-Event Survey for Virtual Attendees
[PHIC] 2024 Science Ambassador Regional Training Workshop Satisfaction Survey	0920-1050-24DX	2024 Science Ambassador Regional Training Workshop Satisfaction Survey
[PHIC] PHHS Block Grant and PHIG Listening Sessions (2024)	0920-1050	Guiding Questions for the PHHS Block Grant and PHIG Listening Session
[PHIC] Strategic Scholars Program Feedback Survey 2024	0920-24HF	Feedback Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	216,000	216,000	0	0	0	0
Annual Time Burden (Hours)	66,750	66,750	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $60,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/23/2022

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