[ATSDR] Social Vulnerability Index (SVI) User Survey

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

Documents and Forms

Document Name Document Type
Form 0923-0047 [ATSDR] Social Vulnerability Index (SVI) User Survey Form and Instruction
0923-0047 SVI User Survey SVI User Survey 2024_Final Draft.docx Form and Instruction
SVI User Survey_Email Draft.docx SVI User Survey Email Invitation IC Document
Request - SVI User Survey.docx 0923-0047 GenIC Request Template IC Document

Information Collection (IC) Details

IC Title:	[ATSDR] Social Vulnerability Index (SVI) User Survey	Agency IC Tracking Number:	0923-0047-25BY

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	0923-0047	SVI User Survey	SVI User Survey 2024_Final Draft.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	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	250	250
Annual IC Time Burden (Hours)	63	63
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SVI User Survey Email Invitation	SVI User Survey_Email Draft.docx	01/15/2025
0923-0047 GenIC Request Template	Request - SVI User Survey.docx	01/15/2025

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