Information Collection Request
RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { border-color: transparent; background-color: transparent; left: 250px; top:75px; width:1px; height:1px; color:black; overflow:hid
ICR 202101-0920-015 · OMB 0920-1327 · RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0920-20QJ Critical Item Survey |
Form and Instruction | New | Repair queued |
| Form 0920-20QJ Main Questionnaire |
Form and Instruction | New | Repair queued |
 Attachment 12 -Privacy impact assessment form.pdf |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
| Attachment 11_ Human subjects document non-research determination.pdf |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
| Attachment 10_Privacy Narrative.pdf |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
 Attachment 7 - Telephone contacting scripts.docx |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
| Attachment 6d_Last chance email.docx |
Supplementary Document | Uploaded 2021-01-26 | Missing upstream |
| Attachment 6c_SAQ cover letter.docx |
Supplementary Document | Uploaded 2021-01-26 | Missing upstream |
| Attachment 6b_Reminder email template.docx |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
| Attachment 6a_Email invitation.docx |
Supplementary Document | Uploaded 2021-01-26 | Missing upstream |
| Attachment 5b - Frequently asked questions.docx |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
| Attachment 5a_Survey invitation letter.docx |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
| Attachment 4_Prenotification letter.docx |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
| Attachment 2a - 60-Day Federal Register Notice.pdf |
Supplementary Document | Uploaded 2021-01-26 | Missing upstream |
| Attachment 1_Public Health Service Act [42 U.S.C. 241].pdf |
Supplementary Document | Uploaded 2021-01-26 | Repair queued |
| OMB Supporting Statement B.docx |
Supporting Statement B | Uploaded 2021-01-26 | Missing upstream |
| OMB Supporting Statement A final.docx |
Supporting Statement A | Uploaded 2021-01-26 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 245435 |  Critical Item Survey |
Form and Instruction | New | |
| 245433 | Main Questionnaire |
Form and Instruction | New |
ICR Details
| Status | RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b |
|---|---|
| Agency/Subagency | RegInfo.gov Technical Difficulties focusMethod = |
| OMB Control No | 0920-1327 |
| Type of Information Collection | RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b |
| Previous ICR Reference No | RegInfo.gov Technical Difficulties focusMethod = |
| Agency Tracking No | RegInfo.gov Technical Difficulties focusMethod = |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |