Information Collection

DIR Objective Review Assessment Survey

IC 265672 under ICR 202406-0906-005 · OMB 0906-0084.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0084 can be found here:

2025-03-28 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
02262024 DIR Review Assessment Survey form 1 - screenshot Reviewer instr.pdf	Instruction
02262024 DIR Review Assessment Survey form 1 - screenshot Reviewer instr.pdf	Instruction
1 Questions 1-5 02262024 FORM CHAIR Q 1-5.pdf	Form and Instruction
1 Questions 1-5 02262024 FORM CHAIR Q 1-5.pdf	Form and Instruction
2 Reviewer Evaluation Form 02262024 FORM Reviewer Evaluation Q 1- 15.pdf	Form and Instruction
2 Reviewer Evaluation Form 02262024 FORM Reviewer Evaluation Q 1- 15.pdf	Form and Instruction
3 Reviewer Evaluation Field Review 02262024 FORM Reviewer Evaluation-Field Review Q 1 - 12.pdf	Form and Instruction
3 Reviewer Evaluation Field Review 02262024 FORM Reviewer Evaluation-Field Review Q 1 - 12.pdf	Form and Instruction
1A Chair Reviewer Evaluation Q1-2 Chair Reviewer Evaluation Review Q1-2.PNG	Form and Instruction
1A Chair Reviewer Evaluation Q1-2 Chair Reviewer Evaluation Review Q1-2.PNG	Form and Instruction
1B Chair Reviewer Evaluation Review Form Q3-4 Chair Reviewer Evaluation Review Q3-4.PNG	Form and Instruction
1B Chair Reviewer Evaluation Review Form Q3-4 Chair Reviewer Evaluation Review Q3-4.PNG	Form and Instruction
1C Chair Reviewer Evaluation Review Q5 Chair Reviewer Evaluation Review Q5.PNG	Form and Instruction
1C Chair Reviewer Evaluation Review Q5 Chair Reviewer Evaluation Review Q5.PNG	Form and Instruction
2A Reviewer Evaluation- Field Review Q1-2 Reviewer Evaluation-Field Review Q1-2.PNG	Form and Instruction
2A Reviewer Evaluation- Field Review Q1-2 Reviewer Evaluation-Field Review Q1-2.PNG	Form and Instruction
2B Reviewer Evaluation- Field Review Q3-4 Reviewer Evaluation-Field Review Q3-4.PNG	Form and Instruction
2B Reviewer Evaluation- Field Review Q3-4 Reviewer Evaluation-Field Review Q3-4.PNG	Form and Instruction
2C Reviewer Evaluation- Field Review Q5-6 Reviewer Evaluation-Field Review Q5-6.PNG	Form and Instruction
2C Reviewer Evaluation- Field Review Q5-6 Reviewer Evaluation-Field Review Q5-6.PNG	Form and Instruction
2D Reviewer Evaluation- Field Review Q7-8 Reviewer Evaluation-Q7-8.PNG	Form and Instruction
2D Reviewer Evaluation- Field Review Q7-8 Reviewer Evaluation-Q7-8.PNG	Form and Instruction
2E Reviewer Evaluation- Field Review Q9-10 Reviewer Evaluation-Field Review Q9-10.PNG	Form and Instruction
2E Reviewer Evaluation- Field Review Q9-10 Reviewer Evaluation-Field Review Q9-10.PNG	Form and Instruction
2F Reviewer Evaluation- Field Review Q11-12 Reviewer Evaluation-Field Review Q11-12.PNG	Form and Instruction
2F Reviewer Evaluation- Field Review Q11-12 Reviewer Evaluation-Field Review Q11-12.PNG	Form and Instruction
3A Reviewer Evaluation Q1-2 Reviewer Evaluation-Q1-2.PNG	Form and Instruction
3A Reviewer Evaluation Q1-2 Reviewer Evaluation-Q1-2.PNG	Form and Instruction
3B Reviewer Evaluation- Field Review Q3-4 Reviewer Evaluation-Q3-4.PNG	Form and Instruction
3B Reviewer Evaluation- Field Review Q3-4 Reviewer Evaluation-Q3-4.PNG	Form and Instruction
3C Reviewer Evaluation- Field Review Q5-6 Reviewer Evaluation-Q5-6.PNG	Form and Instruction
3C Reviewer Evaluation- Field Review Q5-6 Reviewer Evaluation-Q5-6.PNG	Form and Instruction
3E Reviewer Evaluation Q9-10 Reviewer Evaluation-Q9-10.PNG	Form and Instruction
3E Reviewer Evaluation Q9-10 Reviewer Evaluation-Q9-10.PNG	Form and Instruction
3D Reviewer Evaluation- Field Review Q7-8 Reviewer Evaluation-Field Review Q7-8.PNG	Form and Instruction
3D Reviewer Evaluation- Field Review Q7-8 Reviewer Evaluation-Field Review Q7-8.PNG	Form and Instruction
3F Reviewer Evaluation- Field Review Q11-12 Reviewer Evaluation-Q11-12.PNG	Form and Instruction
3F Reviewer Evaluation- Field Review Q11-12 Reviewer Evaluation-Q11-12.PNG	Form and Instruction
3G Reviewer Evaluation- Field Review Q13-14 Reviewer Evaluation-Q13-14.PNG	Form and Instruction
3G Reviewer Evaluation- Field Review Q13-14 Reviewer Evaluation-Q13-14.PNG	Form and Instruction
3H Reviewer Evaluation- Field Review Q15 Reviewer Evaluation-Q15.PNG	Form and Instruction
3H Reviewer Evaluation- Field Review Q15 Reviewer Evaluation-Q15.PNG	Form and Instruction
DIR Objective Review Assessment Survey New 3.4.24.docx DIR Objective Survey Review	IC Document
DIR Objective Review Assessment Survey New 3.4.24.docx DIR Objective Survey Review	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

DIR Objective Review Assessment Survey

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			02262024 DIR Review Assessment Survey form 1 - screenshot Reviewer instr.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	1	Questions 1-5	02262024 FORM CHAIR Q 1-5.pdf	Yes	Yes	Fillable Printable
Form and Instruction	2	Reviewer Evaluation Form	02262024 FORM Reviewer Evaluation Q 1- 15.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	3	Reviewer Evaluation Field Review	02262024 FORM Reviewer Evaluation-Field Review Q 1 - 12.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	1A	Chair Reviewer Evaluation Q1-2	Chair Reviewer Evaluation Review Q1-2.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	1B	Chair Reviewer Evaluation Review Form Q3-4	Chair Reviewer Evaluation Review Q3-4.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	1C	Chair Reviewer Evaluation Review Q5	Chair Reviewer Evaluation Review Q5.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	2A	Reviewer Evaluation- Field Review Q1-2	Reviewer Evaluation-Field Review Q1-2.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	2B	Reviewer Evaluation- Field Review Q3-4	Reviewer Evaluation-Field Review Q3-4.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	2C	Reviewer Evaluation- Field Review Q5-6	Reviewer Evaluation-Field Review Q5-6.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	2D	Reviewer Evaluation- Field Review Q7-8	Reviewer Evaluation-Q7-8.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	2E	Reviewer Evaluation- Field Review Q9-10	Reviewer Evaluation-Field Review Q9-10.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	2F	Reviewer Evaluation- Field Review Q11-12	Reviewer Evaluation-Field Review Q11-12.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	3A	Reviewer Evaluation Q1-2	Reviewer Evaluation-Q1-2.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	3B	Reviewer Evaluation- Field Review Q3-4	Reviewer Evaluation-Q3-4.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	3C	Reviewer Evaluation- Field Review Q5-6	Reviewer Evaluation-Q5-6.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	3E	Reviewer Evaluation Q9-10	Reviewer Evaluation-Q9-10.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	3D	Reviewer Evaluation- Field Review Q7-8	Reviewer Evaluation-Field Review Q7-8.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	3F	Reviewer Evaluation- Field Review Q11-12	Reviewer Evaluation-Q11-12.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	3G	Reviewer Evaluation- Field Review Q13-14	Reviewer Evaluation-Q13-14.PNG	Yes	Yes	Fillable Fileable
Form and Instruction	3H	Reviewer Evaluation- Field Review Q15	Reviewer Evaluation-Q15.PNG	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: 900

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	900	900
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DIR Objective Survey Review	DIR Objective Review Assessment Survey New 3.4.24.docx	03/04/2024

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