Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
'SSPRACTICE' New 31 8 0 Other-WORD
ASPR Temporary Reassignment Request New 60 30 0 Form none ASPR Temporary Reassignment Request
Assessment of Health Dept. Antibiotic Stewardship Roles and Activities New 60 40 0 Other-Interview Guide
Assessment of Tobacco Control Program (TCP) Infrastructure New 51 77 0 Form and Instruction None CMI Measurement Tool
Assessment of Waste Left in Place (WLIP) Ordinances New 100 7 0 Form and Instruction NA Assessment of the Effectiveness of Municipal Waste Left in Place Ordinances - Web Version
Assessment of the 2011 CDC Protocol Change for Flight-Related Tuberculosis Contact Investigations New 125 42 0 Form and Instruction NA Flight-Related TBCI Assessment
Assessment of the 2014 Best Practices Guide for Comprehensive Tobacco Control Programs New 51 60 0 Form and Instruction NA Best Practices Evaluation: Telephone Interview Guide
Assessment of the STD AAPPS Funding Program New 118 197 0 Form none STD AAPPS Assessment Tool
Other-Interview Guide
Assessment of the Tuberculosis Laboratory Aggregate Report New 58 15 0 Form none Assessment of the TB Laboratory Aggregate Report
Awareness and Practice of Disaster Risk Reduction for Health: A National Assessment New 56 9 0 Form and Instruction NA Awareness and Practice of Disaster Risk Reduction for Health: A National Assessment Survey
BE Review (Built Environment) Healthy Community Design: Assessment of Local Health and Planning Departments New 1130 283 0 Form and Instruction None LHD Instrument - Web
Form and Instruction None Planner Instrument
Community Health Status Indicators (CHSI) 2015: Awareness, Use, and Benefits Assessment New 78 37 0 Form and Instruction 16ADY B. Health Director Referral Instrument_CHSI
Form and Instruction 16ADY C. Focus Group Participant Recruitment Instrument_CHSI
Form and Instruction 16ADY D. Focus Group Interview Guide Instrument_CHSI
Community Health Worker Certification: Effective Strategies and Potential Challenges New 49 74 0 Form and Instruction N/A Telephone Interview Guide
County Health Policy Implementation Assessment New 120 47 0 Form none County Health Policy Implementation Assessment - Single-County Web Version
Form none County Health Policy Implementation Assessment - Multi-county - Web Version
Form none County Health Policy Implementation Assessment - Word Version
Form none Additional County Supplement
Early Care and Education (ECE) State Indicator Assessment New 102 30 0 Form and Instruction NA ECE State Indicator Report
Emerging Issues for Private Wells - CSTE Assessment New 55 55 0 Form none EMerging Issues for Private Wells - CSTE Assessment
Form none Emerging Issues for Private Wells - Word
Epi-Aid Satisfaction and Impact Assessment New 60 15 0 Form none Epi-Aid Satsifaction and Impact Assessment
Form none Epi-Aid Satisfaction and Impact Assessment - word version
Federally Unregulated Drinking Water Programs: Assessing Strategies Leading to Policy Change New 18 23 0 Form and Instruction NA Interview Guide
GenIC XDRCI-COST New 45 104 0 Instruction
Instruction
Other-Excel
Instruction
Instruction
Other-WORD
HHS Region VI Virtual Tabletop Exercise Assessment New 140 42 0 Form none Exercise Findings Form
Form none Exercise Feedback Form
HIV Health Improvement Affinity Group Assessment New 146 82 0 Form none HHIAG Assessment - word
Form none HHIAG Assessment - web
Other-Interview Guide
Mass Gathering Outbreaks: Assessment of Frequency, Policy and Communication Strategies New 81 41 0 Form none Survey Screenshots
Instruction
Maternal and Child Health Zika Capacity Assessment New 690 104 0 Form and Instruction NA Local Health Department MCH Zika Capacity Assessment
NGWA_Intervention to Prevent Exposure to Contaminants in Drinking Water New 30 30 0 Other-WORD
Needs Assessment for Developing a Network of LEHPs New 500 125 0 Other-WORD
Other-Screenshots
Non-Infectious Drinking Water Issues CSTE New 55 36 0 Form and Instruction 0920-16NK Att A_CSTEDWA Instrument (Word Version)
Form and Instruction 0920-16NK Att B_CSTEDWA Instrument (Web Version)
Preexposure Prophylaxis: Local Health Dept. Assessment New 500 250 0 Form none PrEP Local Health Department Assessment
Form none PrEP Local Health Department Assessment
Prescription Drug Overdose Prevention for States Program Assessment New 87 174 0 Other-Interview Guide
Preventive Health and Health Services Block Grant Assessment New 61 61 0 Form and Instruction n/a PHHSBG Assessment Questionnaire (administered electronically)
Other-For Reference: WORD version of the questionnaire
Public Health Law Program Needs Assessment New 500 67 0 Form none Public Health Law Program Needs Assessment
Public Health Preparedness Capabilities Assessment (PHEPCAPSUR) New 62 62 0 Other-WORD
Other-Screenshots
RSB Product and STLT Preparedness Assessment New 336 112 0 Other-WORD
Other-Screenshots
STD/HIV Disease Intervention Specialist (DIS) Workforce Assessment New 499 167 0 Form and Instruction NA DIS Enumeration Data Collection Instrument
School Health Resources Assessment: Awareness, Satisfaction, and Utility New 85 16 0 Other-WORD
Other-Web Version
School Health Resources: Assessing Awareness, Satisfaction, and Utility New 127 77 0 Form and Instruction N/A Web-based Assessment Instrument
Form and Instruction N/A State Level Phone Interview Guide
Form and Instruction N/A District Level In-Person Interview Guide
Special Bacteriology Reference Laboratory Assessment New 51 9 0 Form and Instruction 0920-0879 Attachment B- SBRL Instrument - Word Version
Form and Instruction 0920-0879 Attachment C - SBRL Instrument - Web Version Screen Shots
State & Local HH & LPP Programs: Baseline Profile Assessment New 35 5 0 Form and Instruction 0920-0879 Att C InstrumentMSWord
Form and Instruction 0920-0879 Att D Instrument Web Version
State Chronic Disease Prevention and Control Programs: Training Needs New 357 156 0 Form and Instruction NA Contact Instrument - NCCDPHP Training Needs Assessment
Form and Instruction NA Survey - NCCDPHP Training Needs Assessment
State and Local Public Health Planners: Pandemic Preparedness Readiness New 496 341 0 Form and Instruction None PHEP Contact and Assessment Instrument/Email
Form and Instruction None Section I: Vaccination Planning
Form and Instruction None Section III: Medical Care & Countermeasures
Form and Instruction None Section II: Epidemiology and Laboratory
Form and Instruction None Section IV: Healthcare Systems
Form and Instruction None Section V: Community Mitigation
Form and Instruction None Section VI: Public Information and Communication
Form and Instruction None Section VII: Public Health and Immunization Workforce
Syndromic Surveillance: Success Stories from the Field Guide from Not CDC Funded State & Local Health Departments New 34 57 0 Form Attachment C Screen Shots of the Web-based SySSSFF Template
Syndromic Surveillance: Success Stories from the Field from NSSP Awardees New 31 52 0 Form Attachment C Screen Shots of the Web-based Success Story Template
Systematic Identification and Assessment of Sexual Violence Prevention Strategies New 525 424 0 Other-word
Form none Sexual Violence Prevention Strategy Description
Treatment of Pediatric ADHD: An Assessment of State Medicaid Policies New 51 17 0 Form N/A Prior Authorization Policies for Pediatric ADHD Medication Prescriptions
Usability and Needs Assessment of CDC's State, Tribal, Local, and Territorial Gateway Website New 2913 576 0 Form and Instruction n/a STLT Gateway Website Assessment Questionnaire
Other-Reference document: WORD version of Web Quesionnaire Content
Form and Instruction n/a Card Sorting Assessment Instrument for the STLT Gateway
Other-Reference document: WORD version of Card Sorting Instrument Content
VCASSESS New 2181 273 0 Other-WORD
Other-WEB VERSION
Waterborne Disease Prevention: State Program Assessment New 28 28 0 Instruction
genIC Cancer Survivorship Needs Assessment for NCCCProgram Grantees New 65 87 0 Other-WORD
Other-Web Version
Other-WORD
Other-WORD
Other-WORD
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 13033 4624 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title