Information Collection

[OPHDST] National Electronic Disease Surveillance System Base System (NBS) Community Satisfaction Assessment

IC 280963 under ICR 202506-0920-002 · OMB 0920-1050.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NBS Assessment [OPHDST] National Electronic Disease Surveillance System Base System (NBS) Community Satisfaction Assessment	Form and Instruction
NBS Assessment NBS Assessment.docx	Form and Instruction
0920-1050 Template NBS Assessment V2-OMB Passback 2 TC KGK_final.docx GenIC Request Template	IC Document
0920-1050 SSA NBS Assessment.docx SSA Info Box	IC Document

IC Title:

Agency IC Tracking Number:

0920-26-0216

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 and Instruction	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 411

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	411	411
Annual IC Time Burden (Hours)	103	103
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Template		06/15/2026
SSA Info Box		06/15/2026

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

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