Information Collection

Shigella Hypothesis Generating Questionnaire

IC 242975 under ICR 202309-0920-009 · OMB 0920-1307.

Documents and Forms

Document Name Document Type
Form 0920-1307 Shigella Hypothesis Generating Questionnaire Form and Instruction
0920-1307 SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE (English ve Att C1 SHGQ_(Health Department) Phone Interview (English).docx Form and Instruction
0920-1307 SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE (English ve Att C1 SHGQ_(Health Department) Phone Interview (English).docx Form and Instruction
0920-1307 SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE (Spanish ve Att C2. SHGQ (Health Department) Phone Interview_(Spanish version).docx Form and Instruction
0920-1307 SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE (Spanish ve Att C2. SHGQ (Health Department) Phone Interview_(Spanish version).docx Form and Instruction
0920-1307 SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE_Self-admini Att C4 SHGQ_English_Web v2.pdf Form and Instruction
0920-1307 SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE_Self-admini Att C4 SHGQ_English_Web v2.pdf Form and Instruction
0920-1307 CUESTIONARIO SOBRE LA SHIGELLA PARA LA GENERACIÓN DE HIP Att C3 SHGQ_Spanish_Web v2.pdf Form and Instruction
0920-1307 CUESTIONARIO SOBRE LA SHIGELLA PARA LA GENERACIÓN DE HIP Att C3 SHGQ_Spanish_Web v2.pdf Form and Instruction
Att F1 English SHGQ by Mode of collection_FINAL1.docx Att F1 SHGO by Mode of Collections (Englsih) IC Document
Att F1 English SHGQ by Mode of collection_FINAL1.docx Att F1 SHGO by Mode of Collections (Englsih) IC Document
Att F2 Spanish SHGQ by Mode of collection_FINAL1.docx Att F2 SHGO by Mode of Collection (Spanish) IC Document
Att F2 Spanish SHGQ by Mode of collection_FINAL1.docx Att F2 SHGO by Mode of Collection (Spanish) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Shigella Hypothesis Generating Questionnaire	Agency IC Tracking Number:	0920-1307

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1307	SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE (English version)	Att C1 SHGQ_(Health Department) Phone Interview (English).docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1307	SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE (Spanish version) Phone Interview	Att C2. SHGQ (Health Department) Phone Interview_(Spanish version).docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1307	SHIGELLA HYPOTHESIS GENERATING QUESTIONNAIRE_Self-administered Web Survey (English)	Att C4 SHGQ_English_Web v2.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1307	CUESTIONARIO SOBRE LA SHIGELLA PARA LA GENERACIÃN DE HIPÃTESIS (Spanish version) Phone Interview	Att C3 SHGQ_Spanish_Web v2.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 %

	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

Title	Document	Date Uploaded
Att F1 SHGO by Mode of Collections (Englsih)	Att F1 English SHGQ by Mode of collection_FINAL1.docx	10/06/2023
Att F2 SHGO by Mode of Collection (Spanish)	Att F2 Spanish SHGQ by Mode of collection_FINAL1.docx	10/06/2023

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