Information Collection

[OPHDST] CDC ENGAGE Functionality Project

IC 275346 under ICR 202503-0920-028 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25-0088 Conversation guide [OPHDST] CDC ENGAGE Functionality Project	Form
0920-25-0088 Conversation guide Attachment 2_Conversation Guide_CDC ENGAGE.docx	Form
genIC template_CDC ENGAGE.docx GenIC Request	IC Document
Attachment 1_Project Determination_CDC ENGAGE.pdf Determination	IC Document
Emails_CDC ENGAGE.docx Email Notification	IC Document
SSA_CDC ENGAGE.docx SSA	IC Document
SSB_CDC ENGAGE.docx SSB	IC Document

IC Title:

[OPHDST] CDC ENGAGE Functionality Project

Agency IC Tracking Number:

0920-25-0088

IC Status: New

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	0920-25-0088				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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