Information Collection

[NCHHSTP] Customer Service Satisfaction Assessment of Public Health Laboratory Tuberculosis Laboratory Site Visits conducted by CDC DTBE Laboratory Consultants- Online Survey

IC 261371 under ICR 202304-0920-002 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

2026-06-29 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
[NCHHSTP] Customer Service Satisfaction Assessment of Public Health Laboratory Tuberculosis Laboratory Site Visits conducted by CDC DTBE Laboratory Consultants- Online Survey	Form and Instruction
Site Visit Evaluation SiteVisitEvaluation_CDCDTBELBL_RedCap 8.30.22.pdf	Form and Instruction
Site Visit Evaluation (word) Site Visit Evaluation_Immediate Followup 8.30.22.docx	Form and Instruction
NCHHSTP_DTBE_LB_Site Visits_2023_Customer Service GenIC Clearance Template_final.docx GenIC Request Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[NCHHSTP] Customer Service Satisfaction Assessment of Public Health Laboratory Tuberculosis Laboratory Site Visits conducted by CDC DTBE Laboratory Consultants- Online Survey

Agency IC Tracking Number:

0920-1027-23HG

IC Status: New

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
Form and Instruction	n/a	Site Visit Evaluation	SiteVisitEvaluation_CDCDTBELBL_RedCap 8.30.22.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Site Visit Evaluation (word)	Site Visit Evaluation_Immediate Followup 8.30.22.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 58

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	58	58
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Template	NCHHSTP_DTBE_LB_Site Visits_2023_Customer Service GenIC Clearance Template_final.docx	08/02/2023

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