Hypothesis Generating Questionnaire for PulseNet Cluster Code

Standardized National Hypothesis Generating Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0997 can be found here:

Documents and Forms

Document Name Document Type
Form No form number Hypothesis Generating Questionnaire for PulseNet Cluster Code Form
No form number Hypothesis Generating Questionnaire for PulseNet Cluster AttachmentC_SNHGQ questionnaire.pdf Form

Information Collection (IC) Details

IC Title:	Hypothesis Generating Questionnaire for PulseNet Cluster Code	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	No form number	Hypothesis Generating Questionnaire for PulseNet Cluster Code	AttachmentC_SNHGQ questionnaire.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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