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Program Directors
Use of Evidence Based Practices for Comprehensive Cancer Control
OMB: 0920-0921
IC ID: 200083
OMB.report
HHS/CDC
OMB 0920-0921
ICR 201111-0920-002
IC 200083
( )
Documents and Forms
Document Name
Document Type
Program Directors
Form and Instruction
Phone Interview
Attachment C2. Program Directors telephone interview script.docx
Form and Instruction
Scheduling Script
Attachment C4. Program Directors survey scheduling script.docx
Form and Instruction
Web Survey Instrument
Attachment C1. Program Director Web Survey_rev 1 18 2012.docx
Form and Instruction
Attachment C3. Program Directors Advance Letter.docx
Att C3 - Advance Letter
IC Document
Attachment C5. Program Director Follow Up Emails.docx
Att C5 - Follow-up Email
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Program Directors
Agency IC Tracking Number:
Is this a Common Form?
No
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
none
Phone Interview
Attachment C2. Program Directors telephone interview script.docx
No
No
Fillable Fileable
Form and Instruction
none
Scheduling Script
Attachment C4. Program Directors survey scheduling script.docx
No
No
Fillable Fileable
Form and Instruction
none
Web Survey Instrument
Attachment C1. Program Director Web Survey_rev 1 18 2012.docx
Yes
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
66
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
66
0
66
0
0
0
Annual IC Time Burden (Hours)
72
0
72
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att C3 - Advance Letter
Attachment C3. Program Directors Advance Letter.docx
10/31/2011
Att C5 - Follow-up Email
Attachment C5. Program Director Follow Up Emails.docx
10/31/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.