Interviews to solicit feedback on COVID-19 Worker Factsheets

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-20OY Interviews to solicit feedback on COVID-19 Worker Factsheets Form and Instruction
0920-20OY Fact sheet testing interview instrument factsheet testing interview instrument.docx Form and Instruction
0920-0953 GenIC COVID-19 Factsheet 12AUG2020.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Interviews to solicit feedback on COVID-19 Worker Factsheets	Agency IC Tracking Number:	0920-20OY

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	0920-20OY	Fact sheet testing interview instrument	factsheet testing interview instrument.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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	30	30
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	0920-0953 GenIC COVID-19 Factsheet 12AUG2020.docx	08/12/2020

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