Assessment of STLT Public Health Agencies to Guide the Update of CDC/ATSDR Cancer Cluster Guidelines

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Assessment of STLT Public Health Agencies to Guide the Update of CDC/ATSDR Cancer Cluster Guidelines Form
AttC_FocusGroupFacilitatorsGuide.docx Other-Focus group guide
Assessment -word AttA_Assessment_WordVersion.docx Form
Assessment - web AttB_Survey_WebVersion.pdf Form
AttD_InvitationEmail.docx Invitation email IC Document
AttE_ReminderEmail.docx Reminder email IC Document
AttF_FocusGroupDiscussion_ReminderEmail.docx Focus group reminder IC Document
AttG_ATSDR Regions.docx Regions IC Document
CCGDLNS-SSA.docx Supporting statement A IC Document
CCGDLNS-SSB.docx Supporting statement B IC Document

Information Collection (IC) Details

IC Title:	Assessment of STLT Public Health Agencies to Guide the Update of CDC/ATSDR Cancer Cluster Guidelines	Agency IC Tracking Number:	0920-0879-20QF

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Assessment -word	AttA_Assessment_WordVersion.docx	Yes	Yes	Fillable Fileable
Form	none	Assessment - web	AttB_Survey_WebVersion.pdf	Yes	Yes	Fillable Fileable
Other-Focus group guide			AttC_FocusGroupFacilitatorsGuide.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,190	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 Agency Discretion
Annual Number of Responses for this IC	3,190	3,190
Annual IC Time Burden (Hours)	1,715	1,715
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Invitation email	AttD_InvitationEmail.docx	07/13/2020
Reminder email	AttE_ReminderEmail.docx	07/13/2020
Focus group reminder	AttF_FocusGroupDiscussion_ReminderEmail.docx	07/13/2020
Regions	AttG_ATSDR Regions.docx	07/13/2020
Supporting statement A	CCGDLNS-SSA.docx	07/13/2020
Supporting statement B	CCGDLNS-SSB.docx	07/13/2020

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