Lyme and Other Tickborne Diseases Knowledge, Attitude, and Practice Surveys

Lyme and other Tickborne Diseases Knowledge, Attitude, and Practice Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1150 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1150 Lyme and Other Tickborne Diseases Knowledge, Attitude, and Practice Surveys Form and Instruction
0920-1150 Main Survey 4. UpperMidwestTickPreventionStudy_MN20190621.pdf Form and Instruction
0920-1150 Survey Screener 4a. Survey Introduction Eligibility.pdf Form and Instruction
1. Counties for Recruitment.docx Counties for Recruitment IC Document
2. Survey Invitation Postcard Remind.docx Invitation Reminder postcard IC Document
3. Survey Invitation Postcard.docx Invitation Postcard IC Document
5. Thank You Letter.docx Thank You Letter IC Document
6. Withdrawal Letter.docx Withdrawal Letter IC Document
7. CDC Study Website.docx CDC Study Website IC Document
8. HRPO Exemption Determination.docx IRB Determination IC Document
SSA (Kevin Joyce v2)_edited_6.21.19.docx SSA IC Document
SSB.docx SSB IC Document

Information Collection (IC) Details

IC Title:	Lyme and Other Tickborne Diseases Knowledge, Attitude, and Practice Surveys	Agency IC Tracking Number:	0920-1150-19BHO

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	0920-1150	Main Survey	4. UpperMidwestTickPreventionStudy_MN20190621.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1150	Survey Screener	4a. Survey Introduction Eligibility.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,931	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	5,931	5,931
Annual IC Time Burden (Hours)	396	396
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Counties for Recruitment	1. Counties for Recruitment.docx	06/24/2019
Invitation Reminder postcard	2. Survey Invitation Postcard Remind.docx	06/24/2019
Invitation Postcard	3. Survey Invitation Postcard.docx	06/24/2019
Thank You Letter	5. Thank You Letter.docx	06/24/2019
Withdrawal Letter	6. Withdrawal Letter.docx	06/24/2019
CDC Study Website	7. CDC Study Website.docx	06/24/2019
IRB Determination	8. HRPO Exemption Determination.docx	06/24/2019
SSA	SSA (Kevin Joyce v2)_edited_6.21.19.docx	06/24/2019
SSB	SSB.docx	06/24/2019

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