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Customer Feedback on Previously Developed Health Messaging to Promote Vaccination Among Older African American Community Health Workers
Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0990-0379
IC ID: 251266
OMB.report
HHS/HHSDM
OMB 0990-0379
ICR 202206-0990-003
IC 251266
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:
2024-07-08 - No material or nonsubstantive change to a currently approved collection
2024-02-28 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
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
Federal Enterprise Architecture Business Reference Module
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 %
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
Documents for IC
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.