[NCEZID] Hospital System Approach to Collecting Race, Ethnicity, and Language Data

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 267631

Documents and Forms

Document Name Document Type
Form 092061154 [NCEZID] Hospital System Approach to Collecting Race, Ethnicity, and Language Data Form
Form 092061154 [NCEZID] Hospital System Approach to Collecting Race, Ethnicity, and Language Data Form
092061154 NHSN’s REaLI Effort Attachment 1_SDOH Redcap Survey - Final V4.1.docx Form
092061154 NHSN’s REaLI Effort Attachment 1_SDOH Redcap Survey - Final V4.1.docx Form
REaL Data_GenIC Requestv2.docx Request for genIC Approval (24FT) IC Document
REaL Data_GenIC Requestv2.docx Request for genIC Approval (24FT) IC Document
REaL Data_Supporting Statement A (0920-1154)_v3.docx SSA (24FT) IC Document
REaL Data_Supporting Statement A (0920-1154)_v3.docx SSA (24FT) IC Document
REaL Data_Supporting Statement B (0920-1154).docx SSB (24FT) IC Document
REaL Data_Supporting Statement B (0920-1154).docx SSB (24FT) IC Document
Attachment 2_IRB Determination.pdf IRB Determination (24FT) IC Document
Attachment 2_IRB Determination.pdf IRB Determination (24FT) IC Document
Attachment 3_CoLab REaLI final letter_v2.docx CoLab REaLI_Partner's final letter (24FT) IC Document
Attachment 3_CoLab REaLI final letter_v2.docx CoLab REaLI_Partner's final letter (24FT) IC Document
Attachment 4_CoLab reminder 2 w email final.docx CoLab REaLI_2nd reminder w/email (24FT) IC Document
Attachment 4_CoLab reminder 2 w email final.docx CoLab REaLI_2nd reminder w/email (24FT) IC Document
Attachment 5_CoLAB reminder final email.docx CoLab REaLI_final reminder email (24FT) IC Document
Attachment 5_CoLAB reminder final email.docx CoLab REaLI_final reminder email (24FT) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCEZID] Hospital System Approach to Collecting Race, Ethnicity, and Language Data	Agency IC Tracking Number:	0920-1154-24FT

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	092061154	NHSN’s REaLI Effort	Attachment 1_SDOH Redcap Survey - Final V4.1.docx		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: 13	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for genIC Approval (24FT)	REaL Data_GenIC Requestv2.docx	05/28/2024
SSA (24FT)	REaL Data_Supporting Statement A (0920-1154)_v3.docx	05/28/2024
SSB (24FT)	REaL Data_Supporting Statement B (0920-1154).docx	05/15/2024
IRB Determination (24FT)	Attachment 2_IRB Determination.pdf	05/15/2024
CoLab REaLI_Partner's final letter (24FT)	Attachment 3_CoLab REaLI final letter_v2.docx	05/28/2024
CoLab REaLI_2nd reminder w/email (24FT)	Attachment 4_CoLab reminder 2 w email final.docx	05/15/2024
CoLab REaLI_final reminder email (24FT)	Attachment 5_CoLAB reminder final email.docx	05/15/2024

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