Information Collection

[PHIC] CDC Funded Recipient Experience Survey

IC 267334 under ICR 202410-0920-015 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

2026-08-07 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
[PHIC] CDC Funded Recipient Experience Survey	Form and Instruction
CDC Funded Recipient Experience Survey [PHIC] CDC Funded Recipient Experience Survey	Form and Instruction
CDC Funded Recipient Experience Survey AttachA_Instrument-Word-Version.docx	Form and Instruction
CDC Funded Recipient Experience Survey AttachA_Instrument-Word-Version.docx	Form and Instruction
AttachB_Instrument-Web-Version.docx CDC Funded Recipient Experience Survey - Web version	IC Document
AttachB_Instrument-Web-Version.docx CDC Funded Recipient Experience Survey - Web version	IC Document
AttachC_CDC-Survey-Prenotification.docx Survey Pre-Notification	IC Document
AttachC_CDC-Survey-Prenotification.docx Survey Pre-Notification	IC Document
AttachD_Survey-Notification-Email.docx Survey Notification Email	IC Document
AttachD_Survey-Notification-Email.docx Survey Notification Email	IC Document
AttachE_System-Gen-Survey-Reminder-Emails.docx System Generated Survey Reminder Email	IC Document
AttachE_System-Gen-Survey-Reminder-Emails.docx System Generated Survey Reminder Email	IC Document
AttachF_Personal-Survey-Reminder-Email.docx Personal Survey Reminder Email	IC Document
AttachF_Personal-Survey-Reminder-Email.docx Personal Survey Reminder Email	IC Document
AttachG_PO-Final-Reminder-Email.docx Final Email Reminder	IC Document
AttachG_PO-Final-Reminder-Email.docx Final Email Reminder	IC Document
SSA_Apr262024_FRES_final.docx SSA	IC Document
SSA_Apr262024_FRES_final.docx SSA	IC Document
SSB_Apr262024_FRES_final.docx SSB	IC Document
SSB_Apr262024_FRES_final.docx SSB	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[PHIC] CDC Funded Recipient Experience Survey

Agency IC Tracking Number:

0920-0879-24FK

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	n/a				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	533	533
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CDC Funded Recipient Experience Survey - Web version		04/29/2024
Survey Pre-Notification		04/29/2024
Survey Notification Email		04/29/2024
System Generated Survey Reminder Email		04/29/2024
Personal Survey Reminder Email		04/29/2024
Final Email Reminder		04/29/2024
SSA		04/29/2024
SSB		04/29/2024

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

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