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Customer Feedback of state-level traumatic brain injury prevention workers
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0920-1009
IC ID: 213822
OMB.report
HHS/CDC
OMB 0920-1009
ICR 201405-0920-002
IC 213822
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1009 can be found here:
2016-12-12 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Customer Feedback of state-level traumatic brain injury prevention workers
Form and Instruction
TBI Small Group Discussion Protocol
Instrument_GenIC_1009_CustFeedbTBI.docx
Form and Instruction
Request_GenIC_1009_CustFeedbackTBI.docx
Request for Approval
IC Document
Email invite_final 2014_11_17.docx
Email Invitation
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Customer Feedback of state-level traumatic brain injury prevention workers
Agency IC Tracking Number:
15EB
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
TBI Small Group Discussion Protocol
Instrument_GenIC_1009_CustFeedbTBI.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
35
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
35
0
35
0
0
0
Annual IC Time Burden (Hours)
35
0
35
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for Approval
Request_GenIC_1009_CustFeedbackTBI.docx
11/12/2014
Email Invitation
Email invite_final 2014_11_17.docx
11/17/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.