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[OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews
[OS] CDC/ATSDR Formative Research and Tool Development
OMB: 0920-1154
IC ID: 275345
OMB.report
HHS/CDC
OMB 0920-1154
ICR 202507-0920-004
IC 275345
( )
Documents and Forms
Document Name
Document Type
Form 0920-25-0094
[OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews
Form
0920-25-0094 Request
01_Request_OneLab Formative.docx
Form
0920-25-0094 Key Informant
04_Att1_Key Informant.docx
Form
0920-25-0094 Intake Form
06_Att4_Intake Form.docx
Form
02_SSA_OneLab Formative.docx
SSA
IC Document
03_SSB_OneLab Formative.docx
SSB
IC Document
09_Att6_PD+Human Subjects.pdf
Determination
IC Document
07_Att3_Emails.docx
Email Notification
IC Document
08_Att5_Consent Form.docx
Consent form
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews
Agency IC Tracking Number:
0920-25-0094
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
0920-25-0094
Request
01_Request_OneLab Formative.docx
Yes
Yes
Fillable Fileable
Form
0920-25-0094
Key Informant
04_Att1_Key Informant.docx
Yes
Yes
Fillable Fileable
Form
0920-25-0094
Intake Form
06_Att4_Intake Form.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
100
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
0
0
0
0
100
Annual IC Time Burden (Hours)
93
0
0
0
0
93
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA
02_SSA_OneLab Formative.docx
05/20/2025
SSB
03_SSB_OneLab Formative.docx
05/20/2025
Determination
09_Att6_PD+Human Subjects.pdf
05/20/2025
Email Notification
07_Att3_Emails.docx
05/20/2025
Consent form
08_Att5_Consent Form.docx
05/20/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.