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VetoViolence Usability Testing
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0920-1009
IC ID: 221710
OMB.report
HHS/CDC
OMB 0920-1009
ICR 201405-0920-002
IC 221710
( )
⚠️ Notice: This information collection may be referencing outdated material.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
VetoViolence Usability Testing
Form
Survey
Attachment 3-Survey.docx
Form
GenIC Request_ VetoViolence Usability Testing_052016.docx
Request for Approval
IC Document
Attachment 1- Recruitment Letter.docx
Recruitment Letter
IC Document
Attachment 2- Welcome Message.docx
Welcome Message
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
VetoViolence Usability Testing
Agency IC Tracking Number:
16ANY
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
Survey
Attachment 3-Survey.docx
Yes
Yes
Fillable Fileable
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:
60
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
60
0
60
0
0
0
Annual IC Time Burden (Hours)
60
0
60
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for Approval
GenIC Request_ VetoViolence Usability Testing_052016.docx
05/25/2016
Recruitment Letter
Attachment 1- Recruitment Letter.docx
05/25/2016
Welcome Message
Attachment 2- Welcome Message.docx
05/25/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.