Provider Survey

[NCBDDD] CDC's Milestone Tracker App User Surveys

Documents and Forms

Document Name Document Type
Provider Survey Form and Instruction
Milestone Tracker App Provider Survey (English) H_LTSAE MT Provider Survey_01312023.docx Form and Instruction
Milestone Tracker App Provider Survey (English) H_LTSAE MT Provider Survey_01312023.docx Form and Instruction
Milestone Tracker App Provider Survey (Spanish) H.1_LSTAE MT Provider Survey SPANISH_01312023.docx Form and Instruction
Milestone Tracker App Provider Survey (Spanish) H.1_LSTAE MT Provider Survey SPANISH_01312023.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Provider Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form and Instruction	None	Milestone Tracker App Provider Survey (English)	H_LTSAE MT Provider Survey_01312023.docx		Yes	Yes	Fillable Fileable
Form and Instruction	None	Milestone Tracker App Provider Survey (Spanish)	H.1_LSTAE MT Provider Survey SPANISH_01312023.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	8,333	8,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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