First Web Survey Follow-up for Smartphone Users

Use of Smartphones to Collect Information about Health Behaviors: Feasibility Study

Documents and Forms

Document Name Document Type
First Web Survey Follow-up for Smartphone Users Form
Smartphone Web Survey Follow-up Appendix E. First Web Survey Follow-up Smartphone Users_4 08 2013.docx Form
Appendix E2. Invitation for First Web Survey Follow-up for Smartphone Users.docx Invitation for First Web Survey IC Document

Information Collection (IC) Details

IC Title:	First Web Survey Follow-up for Smartphone Users	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	none	Smartphone Web Survey Follow-up	Appendix E. First Web Survey Follow-up Smartphone Users_4 08 2013.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Invitation for First Web Survey	Appendix E2. Invitation for First Web Survey Follow-up for Smartphone Users.docx	04/17/2013

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