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Provider Survey
[NCBDDD] CDC's Milestone Tracker App User Surveys
OMB: 0920-1397
IC ID: 258177
OMB.report
HHS/CDC
OMB 0920-1397
ICR 202212-0920-004
IC 258177
( )
Documents and Forms
Document Name
Document Type
Provider Survey
Form and Instruction
Milestone Tracker App Provider Survey (English)
H_LTSAE MT Provider Survey_01312023.docx
Form and Instruction
Milestone Tracker App Provider Survey (English)
H_LTSAE MT Provider Survey_01312023.docx
Form and Instruction
Milestone Tracker App Provider Survey (Spanish)
H.1_LSTAE MT Provider Survey SPANISH_01312023.docx
Form and Instruction
Milestone Tracker App Provider Survey (Spanish)
H.1_LSTAE MT Provider Survey SPANISH_01312023.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Provider Survey
Agency IC Tracking Number:
Is this a Common Form?
No
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
None
Milestone Tracker App Provider Survey (English)
H_LTSAE MT Provider Survey_01312023.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Milestone Tracker App Provider Survey (Spanish)
H.1_LSTAE MT Provider Survey SPANISH_01312023.docx
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:
100,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
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
100,000
0
100,000
0
0
0
Annual IC Time Burden (Hours)
8,333
0
8,333
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.