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DELTA FOCUS Survey
DELTA FOCUS Program Evaluation
OMB: 0920-0984
IC ID: 207693
OMB.report
HHS/CDC
OMB 0920-0984
ICR 201605-0920-013
IC 207693
( )
Documents and Forms
Document Name
Document Type
DELTA FOCUS Survey
Form
DELTA FOCUS survey
Attachment E_DELTA Focus Survey 5.9.16.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
DELTA FOCUS Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
none
DELTA FOCUS survey
Attachment E_DELTA Focus Survey 5.9.16.pdf
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:
59
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
59
0
59
0
0
0
Annual IC Time Burden (Hours)
59
0
59
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.