CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2

[NCEZID] Information Collection for Tuberculosis Data from Referring Entities to CureTB

Documents and Forms

Document Name Document Type
Form 0920-1186 CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2 Form and Instruction
Attachment A2.a. – Supplemental CureTB Program Partner Satisfaction Assessment Questionnaire 2.pdf Other-Questionnaire annotated with s
Attachment A2.a. – Supplemental CureTB Program Partner Satisfaction Assessment Questionnaire 2.pdf Other-Questionnaire annotated with s
0920-1186 CureTB Partner Feedback Att. G- Questionnaire 2 - Online Survey Preview-no skip logic.pdf Form and Instruction
0920-1186 CureTB Partner Feedback Att. G- Questionnaire 2 - Online Survey Preview-no skip logic.pdf Form and Instruction
Att. K-CureTB Referral Outcome Notification form.pdf CureTB Referral Outcome Notification IC Document
Att. K-CureTB Referral Outcome Notification form.pdf CureTB Referral Outcome Notification IC Document

Information Collection (IC) Details

IC Title:	CureTB Partner Feedback (Satsifaction Assessment) Questionnaire 2	Agency IC Tracking Number:	0920-1186

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1186	CureTB Partner Feedback	Att. G- Questionnaire 2 - Online Survey Preview-no skip logic.pdf		Yes	Yes	Fillable Fileable
Other-Questionnaire annotated with skip logic			Attachment A2.a. – Supplemental CureTB Program Partner Satisfaction Assessment Questionnaire 2.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	50	0	50
Annual IC Time Burden (Hours)	5	0	5
Annual IC Cost Burden (Dollars)	0	-223	223

Documents for IC

Title	Document	Date Uploaded
CureTB Referral Outcome Notification	Att. K-CureTB Referral Outcome Notification form.pdf	02/21/2024

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