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.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0379 SurveyMonkeyQuestionnaire_Updated_12-9-21.pdf	Other-Questionnaire
0990-0379 SurveyMonkeyQuestionnaire_Updated_12-9-21.pdf	Other-Questionnaire
0990-0379-FastTrack Generic Memo_Vaccine Messaging Contract_.docx MEMO	IC Document
0990-0379-FastTrack Generic Memo_Vaccine Messaging Contract_.docx MEMO	IC Document
0990-0379 ORHO_CHW_Survey_Emails_12-7-21.docx EMAIL INSTRUCTIONS	IC Document
0990-0379 ORHO_CHW_Survey_Emails_12-7-21.docx EMAIL INSTRUCTIONS	IC Document

IC Title:

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

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
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

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.