Information Collection

[OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews

IC 275345 under ICR 202506-0920-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-25-0094 [OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews	Form
Form 0920-25-0094 Request [OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews	Form
Form 0920-25-0094 Key Informant [OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews	Form
Form 0920-25-0094 Intake Form [OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews	Form
0920-25-0094 Request 01_Request_OneLab Formative.docx	Form
0920-25-0094 Request 01_Request_OneLab Formative.docx	Form
0920-25-0094 Key Informant 04_Att1_Key Informant.docx	Form
0920-25-0094 Key Informant 04_Att1_Key Informant.docx	Form
0920-25-0094 Intake Form 06_Att4_Intake Form.docx	Form
0920-25-0094 Intake Form 06_Att4_Intake Form.docx	Form
02_SSA_OneLab Formative.docx SSA	IC Document
02_SSA_OneLab Formative.docx SSA	IC Document
03_SSB_OneLab Formative.docx SSB	IC Document
03_SSB_OneLab Formative.docx SSB	IC Document
09_Att6_PD+Human Subjects.pdf Determination	IC Document
09_Att6_PD+Human Subjects.pdf Determination	IC Document
07_Att3_Emails.docx Email Notification	IC Document
07_Att3_Emails.docx Email Notification	IC Document
08_Att5_Consent Form.docx Consent form	IC Document
08_Att5_Consent Form.docx Consent form	IC Document

IC Title:

[OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews

Agency IC Tracking Number:

0920-25-0094

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-25-0094	Yes	Yes	Fillable Fileable
Form	0920-25-0094	Yes	Yes	Fillable Fileable
Form	0920-25-0094	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	93	93
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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