Information Collection

Knowledge, Attitudes, and Practices of Healthcare Professionals Working in Schools Regarding Tickborne Disease Prevention and Lyme Disease in New York State and Maryland

IC 235465 under ICR 201606-0920-021 · OMB 0920-1150.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1150 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1150 Knowledge, Attitudes, and Practices of Healthcare Professionals Working in Schools Regarding Tickborne Disease Prevention and Lyme Disease in New York State and Maryland Form and Instruction
0920-1150 HPWS Survey (online) Attachment_1_HPWS_Survey (Online).pdf Form and Instruction
0920-1150 HPWS Survey (mail) Attachment_1_HPWS Survey (Mail).docx Form and Instruction
Attachment_2_Human_Subjects_010219AB.pdf HS Determination IC Document
Attachment_3_NY_Invitation_Postcard.pdf NY Invitation Postcard IC Document
Attachment_4_NY_Invitation_Flyer_for_Mailing.pdf NY Invitation Flyer for mailing IC Document
Attachment_5_NY_Invitation_Flyer_for_Email.pdf NY Invitation Flyer for email IC Document
Attachment_6_NY_Reminder_Postcard.pdf NY Reminder Postcard IC Document
Attachment_7_NY_Reminder_Flyer_for_Mailing.pdf NY Reminder Flyer for mailing IC Document
Attachment_8_NY_Reminder_Flyer_for_Email.pdf NY Reminder Flyer for email IC Document
Attachment_9_MD_Invitation_Flyer_for_Mailing.pdf MD Invitation Flyer for mailing IC Document
Attachment_10_MD_Invitation_Flyer_for_Email.pdf MD Invitation Flyer for email IC Document
Attachment_11_MD_Reminder_Postcard.pdf MD Reminder Postcard IC Document
Attachment_12_MD_Reminder_Flyer_for_Email.pdf MD Reminder Flyer for email IC Document
Attachment_13_HPWS_Project_Website.pdf HPWS Project Website IC Document
Attachment_14_MD IRB approval letter 030719.pdf MD IRB approval letter IC Document
Attachment_15_NY_IRB_Approval_Letter.pdf NY IRB Approval letter IC Document
SS A_GenIC_SBHP final.docx SSA IC Document
SS B_GenIC_SBHP.docx SSB IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Knowledge, Attitudes, and Practices of Healthcare Professionals Working in Schools Regarding Tickborne Disease Prevention and Lyme Disease in New York State and Maryland	Agency IC Tracking Number:	0920-1150-19AHT

IC Status: New

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	0920-1150	HPWS Survey (online)	Attachment_1_HPWS_Survey (Online).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1150	HPWS Survey (mail)	Attachment_1_HPWS Survey (Mail).docx		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: 3,951	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,951	3,951
Annual IC Time Burden (Hours)	264	264
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
HS Determination	Attachment_2_Human_Subjects_010219AB.pdf	03/27/2019
NY Invitation Postcard	Attachment_3_NY_Invitation_Postcard.pdf	03/27/2019
NY Invitation Flyer for mailing	Attachment_4_NY_Invitation_Flyer_for_Mailing.pdf	03/27/2019
NY Invitation Flyer for email	Attachment_5_NY_Invitation_Flyer_for_Email.pdf	03/27/2019
NY Reminder Postcard	Attachment_6_NY_Reminder_Postcard.pdf	03/27/2019
NY Reminder Flyer for mailing	Attachment_7_NY_Reminder_Flyer_for_Mailing.pdf	03/27/2019
NY Reminder Flyer for email	Attachment_8_NY_Reminder_Flyer_for_Email.pdf	03/27/2019
MD Invitation Flyer for mailing	Attachment_9_MD_Invitation_Flyer_for_Mailing.pdf	03/27/2019
MD Invitation Flyer for email	Attachment_10_MD_Invitation_Flyer_for_Email.pdf	03/27/2019
MD Reminder Postcard	Attachment_11_MD_Reminder_Postcard.pdf	03/27/2019
MD Reminder Flyer for email	Attachment_12_MD_Reminder_Flyer_for_Email.pdf	03/27/2019
HPWS Project Website	Attachment_13_HPWS_Project_Website.pdf	03/27/2019
MD IRB approval letter	Attachment_14_MD IRB approval letter 030719.pdf	03/27/2019
NY IRB Approval letter	Attachment_15_NY_IRB_Approval_Letter.pdf	03/27/2019
SSA	SS A_GenIC_SBHP final.docx	03/27/2019
SSB	SS B_GenIC_SBHP.docx	03/27/2019

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