[NCBDDD](genIC) Feedback Survey for Community Counts Data Viz Tool

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 270185

⚠️ Notice: This information collection may be referencing outdated material.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

2025-07-16 - No material or nonsubstantive change to a currently approved collection
2025-07-09 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Form 0920-1154 [NCBDDD](genIC) Feedback Survey for Community Counts Data Viz Tool Form and Instruction
0920-1154 Feedback Survey for Community Counts Data Viz Tool Att1_(genIC) Screenshots of CC Data Viz Feedback Survey_08092024.docx : www.cdc.gov/hemophilia-community-counts/php/training/community-counts-data-visualization-tool-feedback-survey.html Form and Instruction
0920-1154 Feedback Survey for Community Counts Data Viz Tool Att1_(genIC) Screenshots of CC Data Viz Feedback Survey_08092024.docx : www.cdc.gov/hemophilia-community-counts/php/training/community-counts-data-visualization-tool-feedback-survey.html Form and Instruction
(genIC)_Request for Approval CC Data Viz_08092024.docx Request for Approval genIC "Feedback Survey for Community Counts Data Viz Tool" (24IE) IC Document
(genIC)_Request for Approval CC Data Viz_08092024.docx Request for Approval genIC "Feedback Survey for Community Counts Data Viz Tool" (24IE) IC Document
(genIC) Community Counts Data Viz SSA_08092024.docx genIC SSA (24IE) IC Document
(genIC) Community Counts Data Viz SSA_08092024.docx genIC SSA (24IE) IC Document
(genIC) Community Counts Data Viz SSB_08092024.docx genIC SSB (24IE) IC Document
(genIC) Community Counts Data Viz SSB_08092024.docx genIC SSB (24IE) IC Document
XC Regulatory review.docx XC Regulatory Review (24IE) IC Document
XC Regulatory review.docx XC Regulatory Review (24IE) IC Document
genIC_IRB Determination CC Data Viz_08122024.pdf IRB Determination (24IE) IC Document
genIC_IRB Determination CC Data Viz_08122024.pdf IRB Determination (24IE) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCBDDD](genIC) Feedback Survey for Community Counts Data Viz Tool	Agency IC Tracking Number:	0920-1154-24IE

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	0920-1154	Feedback Survey for Community Counts Data Viz Tool	Att1_(genIC) Screenshots of CC Data Viz Feedback Survey_08092024.docx	: https://www.cdc.gov/hemophilia-community-counts/php/training/community-counts-data-visualization-tool-feedback-survey.html	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: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval genIC "Feedback Survey for Community Counts Data Viz Tool" (24IE)	(genIC)_Request for Approval CC Data Viz_08092024.docx	08/16/2024
genIC SSA (24IE)	(genIC) Community Counts Data Viz SSA_08092024.docx	08/16/2024
genIC SSB (24IE)	(genIC) Community Counts Data Viz SSB_08092024.docx	08/16/2024
XC Regulatory Review (24IE)	XC Regulatory review.docx	08/16/2024
IRB Determination (24IE)	genIC_IRB Determination CC Data Viz_08122024.pdf	08/16/2024

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