DTBE/FSB Rifampin (RIF) Email Assessment

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Document Name Document Type
Att 1 RIF Followup Survey.docx Other-WORD
Customer Service GenIC Clearance Template_Rif Assessment.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	DTBE/FSB Rifampin (RIF) Email Assessment	Agency IC Tracking Number:	0920-1027-21AX

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
Other-WORD			Att 1 RIF Followup Survey.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	122	122
Annual IC Time Burden (Hours)	122	122
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Customer Service GenIC Clearance Template_Rif Assessment.docx	11/15/2020

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