Information Collection

[OPHDST] CDC ENGAGE Functionality Project

IC 275346 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-25-0088 [OPHDST] CDC ENGAGE Functionality Project	Form
Form 0920-25-0088 Conversation guide [OPHDST] CDC ENGAGE Functionality Project	Form
0920-25-0088 Conversation guide Attachment 2_Conversation Guide_CDC ENGAGE.docx	Form
0920-25-0088 Conversation guide Attachment 2_Conversation Guide_CDC ENGAGE.docx	Form
genIC template_CDC ENGAGE.docx GenIC Request	IC Document
genIC template_CDC ENGAGE.docx GenIC Request	IC Document
Attachment 1_Project Determination_CDC ENGAGE.pdf Determination	IC Document
Attachment 1_Project Determination_CDC ENGAGE.pdf Determination	IC Document
Emails_CDC ENGAGE.docx Email Notification	IC Document
Emails_CDC ENGAGE.docx Email Notification	IC Document
SSA_CDC ENGAGE.docx SSA	IC Document
SSA_CDC ENGAGE.docx SSA	IC Document
SSB_CDC ENGAGE.docx SSB	IC Document
SSB_CDC ENGAGE.docx SSB	IC Document

IC Title:

[OPHDST] CDC ENGAGE Functionality Project

Agency IC Tracking Number:

0920-25-0088

IC Status: Unchanged

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	0920-25-0088				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	30	30
Annual IC Time Burden (Hours)	30	30
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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