Assessment of State/Local STD Clinic Directors Perceptions and Attitudes Regarding CDC Field Staff

Surveys of State, Tribal, Local and Territorial (STLT) Governmental Health Agencies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0879 Assessment of State/Local STD Clinic Directors Perceptions and Attitudes Regarding CDC Field Staff Form and Instruction
0920-0879 STD Field Staff ATTACHMENT B Instrument STD Field Staff ATTACHMENT B Instrument-MS Word.docx Form and Instruction
0920-0879 STD Field Staff ATTACHMENT C Instrument-Online STD Field Staff ATTACHMENT C Instrument-Online.docx Form and Instruction
STD Field Staff Supporting Statement A.docx STD Field Staff Supporting Statement A IC Document
STD Field Staff Supporting Statement B.docx STD Field Staff Supporting Statement B IC Document
STD Field Staff ATTACHMENT A FSAC Competency Assessment.pptx STD Field Staff ATTACHMENT A FSAC Competency Assessment IC Document
STD Field Staff ATTACHMENT D Notification Email.docx STD Field Staff ATTACHMENT D Notification Email IC Document
STD Field Staff ATTACHMENT E Reminder Email.docx STD Field Staff ATTACHMENT E Reminder Email IC Document

Information Collection (IC) Details

IC Title:	Assessment of State/Local STD Clinic Directors Perceptions and Attitudes Regarding CDC Field Staff	Agency IC Tracking Number:

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	0920-0879	STD Field Staff ATTACHMENT B Instrument	STD Field Staff ATTACHMENT B Instrument-MS Word.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	STD Field Staff ATTACHMENT C Instrument-Online	STD Field Staff ATTACHMENT C Instrument-Online.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	59	0	0	0	0	0
Annual IC Time Burden (Hours)	30	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
STD Field Staff Supporting Statement A	STD Field Staff Supporting Statement A.docx	08/16/2013
STD Field Staff Supporting Statement B	STD Field Staff Supporting Statement B.docx	08/16/2013
STD Field Staff ATTACHMENT A FSAC Competency Assessment	STD Field Staff ATTACHMENT A FSAC Competency Assessment.pptx	08/16/2013
STD Field Staff ATTACHMENT D Notification Email	STD Field Staff ATTACHMENT D Notification Email.docx	08/16/2013
STD Field Staff ATTACHMENT E Reminder Email	STD Field Staff ATTACHMENT E Reminder Email.docx	08/16/2013

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