[NCEZID] BEAM Dashboard User Feedback Survey

[NCEZID] 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1071 can be found here:

Documents and Forms

Document Name Document Type
[NCEZID] BEAM Dashboard User Feedback Survey Form and Instruction
[NCEZID] BEAM Dashboard User Feedback Survey Form and Instruction
BEAM Dashboard Customer Satisfaction Survey Att 2 - BEAM evaluation survey.pdf Form and Instruction
BEAM Dashboard Customer Satisfaction Survey Att 2 - BEAM evaluation survey.pdf Form and Instruction
OMB BEAM evaluation_final.docx GENIC Template with Brief Project Description and Burden Estimate (BEAM dashboard) IC Document
OMB BEAM evaluation_final.docx GENIC Template with Brief Project Description and Burden Estimate (BEAM dashboard) IC Document
Att 1-BEAM Eval Project Human Subjects Determination.pdf CDC Determination: IRB Approval is Not Required IC Document
Att 1-BEAM Eval Project Human Subjects Determination.pdf CDC Determination: IRB Approval is Not Required IC Document

Information Collection (IC) Details

IC Title:	[NCEZID] BEAM Dashboard User Feedback Survey	Agency IC Tracking Number:	0920-1071-23BV

IC Status: Unchanged

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	BEAM Dashboard Customer Satisfaction Survey	Att 2 - BEAM evaluation survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GENIC Template with Brief Project Description and Burden Estimate (BEAM dashboard)	OMB BEAM evaluation_final.docx	01/06/2023
CDC Determination: IRB Approval is Not Required	Att 1-BEAM Eval Project Human Subjects Determination.pdf	01/06/2023

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