Information Collection

[OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training

IC 266180 under ICR 202505-0920-006 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

2025-06-23 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1050 [OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction
Form 0920-1050 Survey - Jurisdictional public health staff members [OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction
Form 0920-1050 Focus Group - Jurisdictional public health staff members [OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction
Form 0920-1050 Survey - Subject matter experts in populations [OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction
Form 0920-1050 Focus Group - Subject matter experts in populations [OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training	Form and Instruction
0920-1050 Survey - Jurisdictional public health staff members Att A DAP Course Survey for Pilot 03202024.docx	Form and Instruction
0920-1050 Survey - Jurisdictional public health staff members Att A DAP Course Survey for Pilot 03202024.docx	Form and Instruction
0920-1050 Focus Group - Jurisdictional public health staff members Att B DAP focus group guide 03202024.docx	Form and Instruction
0920-1050 Focus Group - Jurisdictional public health staff members Att B DAP focus group guide 03202024.docx	Form and Instruction
0920-1050 Survey - Subject matter experts in populations Att A DAP Course Survey for Pilot 03202024.docx	Form and Instruction
0920-1050 Survey - Subject matter experts in populations Att A DAP Course Survey for Pilot 03202024.docx	Form and Instruction
0920-1050 Focus Group - Subject matter experts in populations Att B DAP focus group guide 03202024.docx	Form and Instruction
0920-1050 Focus Group - Subject matter experts in populations Att B DAP focus group guide 03202024.docx	Form and Instruction
Att C DAP communications to respondents 03202024.docx Communication Instruction to Respondents	IC Document
Att C DAP communications to respondents 03202024.docx Communication Instruction to Respondents	IC Document
0920-1050 DAP SSA New Requirements_03202024.docx SSA Requirement	IC Document
0920-1050 DAP SSA New Requirements_03202024.docx SSA Requirement	IC Document
0920-1050 DAP Template_03202024.docx 0920-1050 GenIC Request Template	IC Document
0920-1050 DAP Template_03202024.docx 0920-1050 GenIC Request Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[OPHDST] Jurisdictional Staff Feedback to Improve Case Interview Training

Agency IC Tracking Number:

0920-1050-24DY

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1050	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	N/A	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 177

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	177	177
Annual IC Time Burden (Hours)	107	107
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Communication Instruction to Respondents		03/21/2024
SSA Requirement		03/21/2024
0920-1050 GenIC Request Template		03/21/2024

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

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