[PHIC] CDC Funded Recipient Experience Survey

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

OMB: 0920-0879

IC ID: 267334

Documents and Forms

Document Name Document Type
[PHIC] CDC Funded Recipient Experience Survey Form and Instruction
[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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	CDC Funded Recipient Experience Survey	AttachA_Instrument-Word-Version.docx		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 %

	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

Title	Document	Date Uploaded
CDC Funded Recipient Experience Survey - Web version	AttachB_Instrument-Web-Version.docx	04/29/2024
Survey Pre-Notification	AttachC_CDC-Survey-Prenotification.docx	04/29/2024
Survey Notification Email	AttachD_Survey-Notification-Email.docx	04/29/2024
System Generated Survey Reminder Email	AttachE_System-Gen-Survey-Reminder-Emails.docx	04/29/2024
Personal Survey Reminder Email	AttachF_Personal-Survey-Reminder-Email.docx	04/29/2024
Final Email Reminder	AttachG_PO-Final-Reminder-Email.docx	04/29/2024
SSA	SSA_Apr262024_FRES_final.docx	04/29/2024
SSB	SSB_Apr262024_FRES_final.docx	04/29/2024

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