Information Collection

[NCEZID] BEAM Dashboard User Feedback Survey

IC 257756 under ICR 202402-0920-010 · OMB 0920-1071.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
[NCEZID] BEAM Dashboard User Feedback Survey	Form and Instruction
BEAM Dashboard Customer Satisfaction Survey Att 2 - BEAM evaluation survey.pdf	Form and Instruction
OMB BEAM evaluation_final.docx GENIC Template with Brief Project Description and Burden Estimate (BEAM dashboard)	IC Document
Att 1-BEAM Eval Project Human Subjects Determination.pdf CDC Determination: IRB Approval is Not Required	IC Document

IC Title:

[NCEZID] BEAM Dashboard User Feedback Survey

Agency IC Tracking Number:

0920-1071-23BV

IC Status: Unchanged

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	None	BEAM Dashboard Customer Satisfaction Survey	Att 2 - BEAM evaluation survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GENIC Template with Brief Project Description and Burden Estimate (BEAM dashboard)	OMB BEAM evaluation_final.docx	01/06/2023
CDC Determination: IRB Approval is Not Required	Att 1-BEAM Eval Project Human Subjects Determination.pdf	01/06/2023

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