Information Collection

Customer Feedback from CDC-Funded CBO about Rapid Feedback Reports

IC 235925 under ICR 201705-0920-017 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Document Name Document Type
Customer Feedback from CDC-Funded CBO about Rapid Feedback Reports Form
Web Assessment Fast Track Request_att 2_Web Assessment Screenshots.docx Form
PD 7211 PEB_CBO_RFR Survey Non Research Determination Form LJF.pdf Non-research determination IC Document
Fast Track Request_att 1_Web Assessment Questions.docx Web Assessment - word version IC Document
Fast Track Request Form_Customer Feedback.docx Request for Approval IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Customer Feedback from CDC-Funded CBO about Rapid Feedback Reports	Agency IC Tracking Number:	0920-1027-19AQJ

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	none	Web Assessment	Fast Track Request_att 2_Web Assessment Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 238	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	476	476
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Non-research determination	PD 7211 PEB_CBO_RFR Survey Non Research Determination Form LJF.pdf	05/02/2019
Web Assessment - word version	Fast Track Request_att 1_Web Assessment Questions.docx	05/02/2019
Request for Approval	Fast Track Request Form_Customer Feedback.docx	05/02/2019

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