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Federal forms, ICRs, and supporting documents

Information Collection

Customer Feedback on Previously Developed Health Messaging to Promote Vaccination Among Older African American Community Health Workers

IC 251266 under ICR 202206-0990-003 · OMB 0990-0379.

Documents and Forms
Document Name
Document Type
Other-Questionnaire
Other-Questionnaire
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Customer Feedback on Previously Developed Health Messaging to Promote Vaccination Among Older African American Community Health Workers
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Questionnaire 0990-0379 SurveyMonkeyQuestionnaire_Updated_12-9-21.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

500 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 500 0 0 0 0 500
Annual IC Time Burden (Hours) 125 0 0 0 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
MEMO 0990-0379-FastTrack Generic Memo_Vaccine Messaging Contract_.docx 01/25/2022
EMAIL INSTRUCTIONS 0990-0379 ORHO_CHW_Survey_Emails_12-7-21.docx 01/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.