Information Collection Request

[NCSTLTPHIW] Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

ICR 202410-0920-015 · OMB 0920-0879 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
[PHIC/NCHHSTP] 2024 TB Training and Education Needs Assessment – The U.S.-affiliated Pacific Islands – Online Survey Form and Instruction Unchanged Available
[PHIC/NCHHSTP] 2024 TB Training and Education Needs Assessment – The U.S.-affiliated Pacific Islands – Online Survey Form and Instruction Unchanged Repair queued
Form 0920-0879 [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) Form Unchanged Available
Form 0920-0879 [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) Form Unchanged Repair queued
Form 0920-0879 [PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns Form and Instruction Unchanged Available
Form 0920-0879 [PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns Form and Instruction Unchanged Repair queued
[PHIC] CDC Funded Recipient Experience Survey Form and Instruction Unchanged Available
[PHIC] CDC Funded Recipient Experience Survey Form and Instruction Unchanged Repair queued
[PHIC] OT21-2103 Success Stories (2024-2026) Form and Instruction Unchanged Available
[PHIC] OT21-2103 Success Stories (2024-2026) Form and Instruction Unchanged Missing upstream
Form 0920-0879 [PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN) Form and Instruction Unchanged Available
Form 0920-0879 [PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN) Form and Instruction Unchanged Missing upstream
AttG4_SurveyExtensionEmail.docx Supplementary Document Uploaded 2024-10-15 Available
AttG4_SurveyExtensionEmail.docx Supplementary Document Uploaded 2024-10-15 Available
0920-0879 MAHC Change Request_10112024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-10-15 Available
0920-0879 MAHC Change Request_10112024.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-10-15 Repair queued
Attachment B - Approved GenICs under 0920-0879.docx Supplementary Document Uploaded 2023-06-20 Available
Attachment B - Approved GenICs under 0920-0879.docx Supplementary Document Uploaded 2023-06-20 Repair queued
Attachment C - 60 Day Federal Register Notice.pdf Supplementary Document Uploaded 2023-06-20 Available
Attachment C - 60 Day Federal Register Notice.pdf Supplementary Document Uploaded 2023-06-20 Missing upstream
Attachment A - Public Health Service Act.pdf Supplementary Document Uploaded 2023-06-20 Available
Attachment A - Public Health Service Act.pdf Supplementary Document Uploaded 2023-06-20 Repair queued
SSB 0920_0879 extension.docx Supporting Statement B Uploaded 2023-06-20 Available
SSB 0920_0879 extension.docx Supporting Statement B Uploaded 2023-06-20 Repair queued
SSA 0920_0879_06142023_updated.docx Supporting Statement A Uploaded 2023-06-20 Available
SSA 0920_0879_06142023_updated.docx Supporting Statement A Uploaded 2023-06-20 Repair queued

IC Document Collections

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2026 08/31/2026 08/31/2026
162,000 0 162,000
162,000 0 162,000
0 0 0





Reginfo record details
6
table that charts list of burden
IC Title Form No. Form Name
[PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) 0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879 MAHC Use and Acceptability Survey (EpiInfo Web Survey) ,   Focus Group Discussion Guide—Moderate MAHC Use and Implementation ,   Focus Group Discussion Guide—Moderate MAHC Use and Implementation ,   Focus Group Discussion Guide—Advanced MAHC Use and Implementation ,   Case Study In-Depth Interview Guide
[PHIC/NCHHSTP] 2024 TB Training and Education Needs Assessment – The U.S.-affiliated Pacific Islands – Online Survey n/a 2024 Tuberculosis (TB) Training and Education Needs Assessment of the U.S.-affiliated Pacific Islands
[PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN) 0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879 PEDIATRIC HEPATITIS OF UNKNOWN ETIOLOGY MEDICAL RECORD ABSTRACTION FORM ,   Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire (Parental Interview) ,   Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire CONTROL (Parental Interview) ,   Hepatitis pediátrica de etiología desconocida - Cuestionario sobre exposiciones (entrevista a los padres) ,   Hepatitis pediátrica de etiología desconocida. CONTROL del cuestionario sobre exposiciones (Entrevista a los padres)
[PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns 0920-0879, 0920-0879 O2DA Partner Evaluation Survey: Screener and Annotated Questionnaire ,   O2DA Partner Evaluation Survey: Screener and Annotated Questionnaire
[PHIC] CDC Funded Recipient Experience Survey n/a CDC Funded Recipient Experience Survey
[PHIC] OT21-2103 Success Stories (2024-2026) n/a OT20-2103 Success Stories Form

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 162,000 162,000 0 0 0 0
Annual Time Burden (Hours) 162,000 162,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No