Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2020 Carbapenem Resistance Veterinary Diagnostic Laboratory Survey New 51 17 543 Form and Instruction n/a 2020 Carbapenem Resistance Veterinary Diagnostic Laboratory Survey
Other-WORD version of survey to facilitate review of content
Assessment of Colorectal Cancer Control Program Implementation at Health System Clinic Sites New 393 131 0 Other-Web Version
Form and Instruction 0920-20PX Colo-rectal Cancer Control Program Survey
Assessment of Partnerships Impacting STD Outcomes in Areas of Service Reduction New 184 132 0 Form and Instruction 0920-0879 STD Program Manager Referral Form
Form and Instruction 0920-0879 In-Person Interview Referral Form
Form and Instruction 0920-0879 Web-based Assessment Instrument
Form and Instruction 0920-0879 In-Person Interview Guide - Local STD Program Manager
Form and Instruction 0920-0879 In-Person Interview Guide - Local STD Program Coordinator
Form and Instruction 0920-0879 In-Person Interview Guide - Local Data Manager/Epidemiologist
Assessment of STLT Public Health Agencies to Guide the Update of CDC/ATSDR Cancer Cluster Guidelines New 3190 1715 0 Form none Assessment -word
Form none Assessment - web
Other-Focus group guide
Assessment of the National Health Security Index for Public Health Preparedness New 320 290 0 Form none National Health Security Preparedness Index Assessment
Form none National Health Security Preparedness Index Assessment - word
Other-Interview guide
CDC Newborn Screening Quality Assurance Program – Spinal Muscular Atrophy (SMA) Proficiency Testing (PT) Pilot New 40 9 457 Form and Instruction n/a NSQPA Pilot SMA PT Data Reporting Form
Form and Instruction n/a NSQAP Pilot SMA PT Program Customer Feedback Form
CDC Project Officer Support: SHD Officials Assessment New 969 404 0 Other-WORD
Form and Instruction 0920-0879 CDC Projct Oficer Effectiveness and Satisfaction Assessment: Instrument Guidance
Community of Practice Member Satisfaction and Needs Assessment New 295 74 0 Form none Community of Practice Assessment - word
Form none Community of Practice Assessment - web
DROUGHT-IC New 3440 1147 0 Form and Instruction 0920-0879 DROUGHT Preparedness and Response Assessment Tool (DEMO)
Other-WORD
Determining the Landscape of QMSs for PHLs Performing NGS (LD) New 57 38 0 Form and Instruction 0920-20PD NGSQUAL-NA
EBP-PHPR New 562 328 0 Form none Assessment - Web version
Form none Assessment - Word version
Environmental Health Workforce Current and Emerging Challenges Assessment New 1036 177 0 Form and Instruction 0920-0879 Recruitment Instrument - State Health Department EH Professional
Form and Instruction 0920-0879 Recruitment Instrument - Tribal Health Department EH Professional
Form and Instruction 0920-0879 Recruitment Instrument - Local Health Department EH Professional
Form and Instruction 0920-0879 Recruitment Instrument - Territorial Health Department EH Professional
Form and Instruction 0920-0879 Focus Group Facilitation Guide - STLT EH Professionals
HIV Partner Services HIPEP Assessment New 60 60 0 Form none Partner Services Assessment - web
Form none Partner Services Assessment - word
Medical Countermearsure Training Needs Assessment New 2174 637 0 Other-Electronic Version
Other-Electronic version
Other-Electronic Version
NCCCP Program Improvement Assessment New 67 50 0 Form none NCCCP Assessment - word
Form none NCCCP Assessment
NOFO: Assessment of Language and Structure New 775 335 0 Form none NOFO Assessment
Other-Interview Guide
NSSP BioSense Platform User Assessment: Functionality and Utility New 218 73 2664 Form and Instruction n/a The NSSP BioSense Platform User Assessment
Other-This is a Word version of the instrument to facilitate review of content
National Syndromic Surveillance Program Community of Practice Assessment New 153 38 0 Form none Community of Practice Assessment - word
Form none Community of Practice - web
PHEP Success Story Assessment New 62 5 0 Form and Instruction 0920-0879 PHEP Instrument Web
Form and Instruction 0920-0879 PHEP Instrument Word version
Pandemic Influenza: Assessing the Feasibility and Acceptability of Implementing the 2017 Community Mitigation Guidelines and Recommendations (CMG-EVAL) New 878 1317 48501 Form and Instruction n/a SurveyMonkey Survey for the Directors of Public Health Preparedness
Form and Instruction n/a Qualtrics Survey for Local Health Department Preparedness Coordinators
Other-Word version of survey to facilitate review of content
Pre-Hospital Stroke Systems of Care: Emergency Medical Service System (EMSS) Implementation Assessment New 48 72 0 Form and Instruction 0920-0879 Interview Guide
Prevention and Control of Shigellosis: A Needs Assessment of State and Local Health Departments New 80 80 3292 Form and Instruction n/a Telephone Interview guide
Public Health Ethics Activities at State and Local Health Departments: Current Status and Challenges New 88 23 1067 Form and Instruction 0920-0879 Telephone Interview Guide
Form and Instruction 0920-0879 Online Survey Instrument_Web version
Public Health in Indian Country Capacity Scan Assessment (PHICCS) New 261 261 0 Form and Instruction 0920-0879 PHICCS Instrument - Web Version
Form and Instruction 0920-0879 PHICCS Phone Administration of Instrument - Introduction
Form and Instruction 0920-0879 PHICCS Phone Administration of Instrument - Word Version
Qualitative Assessment of CDC-funded Local Health Dept Violence Prevention Efforts New 22 20 0 Other-Interview Guide
RAWMILKPR - Unpasteurized Milk Outbreaks: An Assessment of the Legal Landscape, Outbreak Investigations, and Prevention at the State Leve New 700 234 0 Other-Screenshots
Form and Instruction 0920-0879 Unpasteurized Milk Outbreak Prevention Survy
SLPHERLT New 762 283 12217 Form and Instruction 0920-0879 Web-Based Assessment
Form and Instruction 0920-0879 Focus Group Facilitation Guide
STD Prevention and Control: Workplan Template Pilot New 59 272 0 Form none STD Applicant Workplan Template - 5 year plan
Form none STD Applicant Workplan Template - 1 year plan
Spinal Muscular Atrophy (SMA) Proficiency Testing (PT) Pilot New 80 6 0 Form and Instruction none Data Reporting Page
Form and Instruction none Feedback Form
State Oral Health Program Assessment New 51 31 2077 Other-Word version of the Online Survey (for reference)
Form and Instruction n/a Online Survey (screen captures)
Form and Instruction n/a Telephone Interview Guide for State Oral Health Staff
State Oral Health and Chronic Disease Programs Integration Assessment New 12 10 547 Form and Instruction n/a Telephone Interview Instrument
The State of State Suicide Prevention: An Environmental Scan New 213 96 0 Form and Instruction 0920-0879 Suicide Prevention Web-based Survey - STT Suicide Prevention Coordinators
Form and Instruction 0920-0879 Suicide Prevention Web-based Survey - STT Suicide Prevention Grant Project Directors
Form and Instruction 0920-0879 Suicide Prevention Web-based Survey - Delegates
Form and Instruction 0920-0879 Suicide Prevention Telephone-based Survey - STT Suicide Prevention Coordinators
Vector Surveillance and Control Assessment: Post Zika-Response and Tick Capacities (VECTOR-PZ) New 3000 450 19980 Form and Instruction n/a 2020 Vector Control Assessment
Other-WORD version of survey content to facilitate review
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 20300 8815 91345  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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