Information Collection

Shigella Hypothesis Generating Questionnaire

IC 242975 under ICR 202209-0920-002 · OMB 0920-1307.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1307 can be found here:

2023-10-06 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Shigella Hypothesis Generating Questionnaire	Form and Instruction
SHGQ Interviewer-administered (English) with FALL 2022 c Appendix D. SHGQ_English_Health Department Phone_UPDATED_08.02.2022.docx	Form and Instruction
SHGQ Interviewer-administered (English) with FALL 2022 c Appendix D. SHGQ_English_Health Department Phone_UPDATED_08.02.2022.docx	Form and Instruction
SHGQ Interviewer-administered (Spanish) with FALL 2022 c Appendix E. SHGQ_Spanish_Health Department Phone_FINAL_08.03.2022.docx	Form and Instruction
SHGQ Interviewer-administered (Spanish) with FALL 2022 c Appendix E. SHGQ_Spanish_Health Department Phone_FINAL_08.03.2022.docx	Form and Instruction
SHGQ Self-administered Web Survey (English) with FALL 20 Appendix G. SHGQ_English_Web.pdf	Form and Instruction
SHGQ Self-administered Web Survey (English) with FALL 20 Appendix G. SHGQ_English_Web.pdf	Form and Instruction
SHGQ Self-administered Web Survey (Spanish) with FALL 20 Appendix E. SHGQ_Spanish_Web.pdf	Form and Instruction
SHGQ Self-administered Web Survey (Spanish) with FALL 20 Appendix E. SHGQ_Spanish_Web.pdf	Form and Instruction
Appendix G. SHGQ_English_Web_TRACK_08.02.2022.docx Edited content for the Self-administered Web Survey (English)	IC Document
Appendix G. SHGQ_English_Web_TRACK_08.02.2022.docx Edited content for the Self-administered Web Survey (English)	IC Document
Appendix H. SHGQ_Spanish_Web_FINAL_08.02.2022.docx Edited content for the Self-administered Web Survey (Spanish)	IC Document
Appendix H. SHGQ_Spanish_Web_FINAL_08.02.2022.docx Edited content for the Self-administered Web Survey (Spanish)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Shigella Hypothesis Generating Questionnaire

Agency IC Tracking Number:

0920-20HD

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	None	SHGQ Interviewer-administered (English) with FALL 2022 changes	Appendix D. SHGQ_English_Health Department Phone_UPDATED_08.02.2022.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	SHGQ Interviewer-administered (Spanish) with FALL 2022 changes	Appendix E. SHGQ_Spanish_Health Department Phone_FINAL_08.03.2022.docx	Yes	Yes	Fillable Fileable
Form and Instruction	None	SHGQ Self-administered Web Survey (English) with FALL 2022 changes	Appendix G. SHGQ_English_Web.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	None	SHGQ Self-administered Web Survey (Spanish) with FALL 2022 changes	Appendix E. SHGQ_Spanish_Web.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: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	1,125	1,125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Edited content for the Self-administered Web Survey (English)	Appendix G. SHGQ_English_Web_TRACK_08.02.2022.docx	09/01/2022
Edited content for the Self-administered Web Survey (Spanish)	Appendix H. SHGQ_Spanish_Web_FINAL_08.02.2022.docx	09/01/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.