[OPHDST] CDC ENGAGE Functionality Project

[OS] CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-25-0088 [OPHDST] CDC ENGAGE Functionality Project Form
0920-25-0088 Conversation guide Attachment 2_Conversation Guide_CDC ENGAGE.docx Form
genIC template_CDC ENGAGE.docx GenIC Request IC Document
Attachment 1_Project Determination_CDC ENGAGE.pdf Determination IC Document
Emails_CDC ENGAGE.docx Email Notification IC Document
SSA_CDC ENGAGE.docx SSA IC Document
SSB_CDC ENGAGE.docx SSB IC Document

Information Collection (IC) Details

IC Title:	[OPHDST] CDC ENGAGE Functionality Project	Agency IC Tracking Number:	0920-25-0088

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	0920-25-0088	Conversation guide	Attachment 2_Conversation Guide_CDC ENGAGE.docx		Yes	Yes	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: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request	genIC template_CDC ENGAGE.docx	05/20/2025
Determination	Attachment 1_Project Determination_CDC ENGAGE.pdf	05/20/2025
Email Notification	Emails_CDC ENGAGE.docx	05/20/2025
SSA	SSA_CDC ENGAGE.docx	05/20/2025
SSB	SSB_CDC ENGAGE.docx	05/20/2025

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