[NCIPC] Core State Injury Prevention Program (Core SIPP)

[OADC] CDC Usability and Digital Content Testing

Documents and Forms

Document Name Document Type
Form 0920-1050 [NCIPC] Core State Injury Prevention Program (Core SIPP) Form and Instruction
0920-1050 Group TA Feedback GroupTAFeedback_CoreSIPP_Att 2.pdf Form and Instruction
0920-1050 Individual TA Feedback IndividualTAFeedback_CoreSIPP_Att 1.pdf Form and Instruction
0920-1050_GenIC_CoreSIPP_TA Feedback.docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” IC Document
CORE SIPP-PII-Privacy Act-Determination-SSPO.pdf Privacy Act Determination IC Document

Information Collection (IC) Details

IC Title:	[NCIPC] Core State Injury Prevention Program (Core SIPP)	Agency IC Tracking Number:	0920-1050-24GM

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	0920-1050	Group TA Feedback	GroupTAFeedback_CoreSIPP_Att 2.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Individual TA Feedback	IndividualTAFeedback_CoreSIPP_Att 1.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 320	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	320	320
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”	0920-1050_GenIC_CoreSIPP_TA Feedback.docx	06/20/2024
Privacy Act Determination	CORE SIPP-PII-Privacy Act-Determination-SSPO.pdf	06/20/2024

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