Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2021 CDC Novel Emerging Respiratory Disease [NERD] Academy Surveys [CSELS] New 1041 175 0 Form and Instruction n/a NERD Academy Participant Survey (screenshots)
Form and Instruction n/a NERD Academy Webpage Survey (screenshots)
Other-WORD document to facilitate review of Participant Survey content
Other-WORD document to facilitate review of Webpage Survey content
New Science Ambassador Virtual Training Series Survey New 332 55 0 Form and Instruction 0920-20QM 2020 Science Ambassador Virtual Training Series Satisfaction Survey
"Lyme and other Tickborne Diseases Knowledge, Attitude, and Practice Surveys" New 115 39 0 Form 0920-1050 A Survey of NJ Mosquito Control Agencies Regarding the Management of Ticks and Tick-borne Disease
Form and Instruction 0920-1050 Survey of NJ Local and County Public Health Agencies Regarding Tick and Tick=borne Disease Managment
2020 EIS Virtual Recruitment and Match Customer Service Survey New 135 11 0 Form and Instruction 0920-20OI 2020 EIS Virtual Recruitment and Match Customer Service Survey
2020 Science Ambassador Application Survey New 90 15 0 Form and Instruction 0920-1050 2020 Science Ambassador Application Survey
Other-WORD (Screenshots)
Other-Email
Other-Email
2020 Science Ambassador Regional Training Workshops Satisfaction Survey New 50 10 0 Form and Instruction 0920-20IS 2020 Science Ambassador Regional Training Workshop Satisfaction Survey
2020 – 2021 CDC Science Ambassador Program Activities Survey New 332 55 0 Form and Instruction 0920-21IJ 2020-2021 CDC Science Ambassador Program Activities Survey
2021 CDC Laboratory Courses for External Audiences Learner Feedback Survey New 10000 1667 0 Form and Instruction None 2021 CDC Laboratory Training Courses Learner Feedback Survey (External Audiences)
2021 EIS Virtual Recruitment and Match Customer Service Survey New 266 22 0 Form and Instruction 0920-1050 2021 EIS Customer Feedback Survey
2022 EIS Conference and Match Feedback Surveys New 1251 125 0 Form and Instruction 0920-1050 2022 EIS Conference Customer Service Feedback Survey
Form and Instruction 0920-1050 2022 EIS MATCH Customver Service Feedback Survey
2022 EpiEpidemic Intelligence Service (EIS) Conference and Match Feedback Surveys New 1251 125 0 Form 0920-22EE Att_1_0920-1050_2022_EIS_Conf_Cust_Serv_Fdbk_Survey
Form and Instruction 0920-22EE Att_6_0920-1050_2022_EIS_Match_Cust_Serv_Fdbk_Survey
ATSDR Public Health Assessment Basic Course Modernization Focus Group New 28 56 0 Other- Facilitators Guide
An Assessment of the Feasibility and Sustainability of CDC Zika Activities Funded Under the USAID/CDC Interagency Agreement New 25 25 0 Form and Instruction n/a Interview guide exploring crosscutting areas associated with sustainability
App and Web Usability Study for CDC's STD Treatment Guidelines New 45 23 0 Form and Instruction 0920-1050 User Testing Questions for STD Tx Guide Mobile App and Website
Assessing Perceptions of Operational Planning Workshops to Facilitate Country Planning for Increasing Health Security Capacities New 30 5 0 Form and Instruction 0920-1050 Operational Planning Workshops Survey
Assessing Perceptions of Operational Planning Workshops to Facilitate Country Planning for Increasing Health Security Capacities New 30 3 0 Instruction
Assessment of National Public Health Institutes'(NPHI) Capacity to Strengthen Essential Public Health Functions in Countries Supported by U.S. Centers for Disease Control and Prevention New 150 113 0 Form and Instruction N/A Interview Protocol - Assessment of NPHI Capacity
CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey New 800 67 0 Form and Instruction n/a CDC Basic Molecular Biology eLearning Courses Learner Feedback Survey
CDC INFO Email Survey [ALT title: CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries)] New 288 29 0 Form and Instruction n/a Survey (English language)
Form and Instruction n/a Survey (Spanish)
CDC Import Permit Program (IPP) Inspection Feedback Survey New 100 17 0 Form and Instruction n/a CDC Import Permit Program (IPP) Inspection Feedback Survey
CDC Laboratory Courses for External Audiences Learner Feedback Survey New 8000 1333 0 Form and Instruction 0920-1050 2020 CDC Laboratory Courses for External Audiences Learner Feedback Survey
CDC Laboratory Identification of Emerging Pathogenic Molds Course Learner Feedback Survey New 40 3 0 Form and Instruction 0920-20DJ 920-20DJ
CDC Microbiology-Oriented eLearning Courses Learner Feedback Survey New 2000 333 0 Form none eLearning Course Feedback Survey
CDC Packaging and Shipping Division 6.2 Materials eLearning Course Learner Feedback Survey New 2000 167 0 Form and Instruction 0920-1050 Customer Survey
CDC Science Ambassador Virtual Training Series Survey New 996 102 0 Form and Instruction 0920-1050 Respondents - No Attendance Session Scheduling (Fall)
Form and Instruction 0920-1050 Respondents - No Attendance Session Scheduling (Spring)
Form and Instruction 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (1 survey)
Form and Instruction 0920-1050 Training Effectiveness Follow-up (Fall) OR Training Effectiveness Follow-up (Spring)
Form and Instruction 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (2 surveys)
Form and Instruction 0920-1050 Training Effectiveness Follow-up (Fall)
Form and Instruction 0920-1050 Training Effectiveness Follow-up (Spring)
Form and Instruction 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (3 surveys)
Form and Instruction 0920-1050 Training Effectiveness Follow-up (Fall)
Form and Instruction 0920-1050 Training Effectiveness Follow-up (Spring)
Form and Instruction 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (4 surveys)
Form and Instruction 09201050 Training Effectiveness Follow-up (Fall)
Form and Instruction 0920-1050 Training Effectiveness Follow-up (Spring)
Form and Instruction 0920-1050 CDC Science Ambassador Virtual Training Series Satisfaction Survey (5 surveys)
Form and Instruction 0920-1050 Training Effectiveness Follow-up (Fall)
Form and Instruction 0920-1050 Training Effectiveness Follow-up (Spring)
CDC-INFO IVR Satisfaction Survey (for Individual Respondents Who Inquire by Phone) New 33100 1103 0 Form and Instruction n/a Interactive Voice Response Survey (English language)
Form and Instruction n/a Interactive Voice Response Survey (Spanish language)
CDC-INFO IVR Satisfaction Survey (for Private Sector Respondents Who Inquire by Phone) New 4900 163 0 Form and Instruction n/a Survey (English language)
Form and Instruction n/a Survey (Spanish language)
CDC-INFO Interactive Voice Response (IVR) Satisfaction Survey (for Individual Respondents Who Inquirer by Phone) New 93000 4650 0 Form and Instruction 0920-1050 IVR Survey (Individual)
CDC-INFO Interactive Voice Response (IVR) Satisfaction Survey (for Private Respondents Who Inquirer by Phone) New 14000 700 0 Form and Instruction 0920-1050 IVR Survey (Private)
CDC-INFO Web-based Satisfaction Survey (for Individual Respondents Who Send Email Inquiries) New 1600 187 0 Form and Instruction 0920-1050 Email Survey Questionnaire
CDC-INFO Web-based Satisfaction Survey (for Private Respondents Who Send Email Inquiries) New 970 113 0 Form and Instruction 0920-1050 Email Survey Questionnaire
CDC-INFO Web-based Satisfaction Survey (for Private Sector Respondents Who Send Email Inquiries) New 120 12 0 Form and Instruction n/a Survey (English language)
Form and Instruction n/a Survey (Spanish language)
Centers for Disease Control and Prevention's National Contact Center (CDC-INFO) Web-based Satisfaction Survey New 186 6 0 Form and Instruction 0920-22AZ 20211025_CDC-INFO Post Chat Survey V5
Clinical Laboratory Partners Forum (CLPF) 2021 Survey New 40 7 0 Form and Instruction n/a Clinical Lab Partners Forum Survey 2021
Customer Experience using the PRAMS Integrated Data Collection System New 150 37 0 Form and Instruction PIDS User Feedback 0920-21BX
Customer Feedback for Raising Healthy Boys New 216 154 0 Other-WORD
Form 0920-1050 Participant Screening Form
Customer Feedback on CAMP Teen-SPARC Tool Use and Usability New 100 17 0 Form and Instruction 0920-1050 SPARC Survey
Customer Satisfaction with the Division of Global Heath and Tuberculous (DGHT) Science Integrity Branch (SIB) Trainings (2021-2022) New 400 33 0 Form and Instruction n/a DGHT SIB Training Assessment Form
Other-Screen capture of landing page for online version (verifies display of OMB control information)
DELTA Reverse Site Visit Feedback New 120 15 0 Form and Instruction 0920-1050 2020 Reverse Site Visit Feedback Form
Other-Email
DSAT Webinar, Webcast, and Workshop Survey New 2264 377 0 Form and Instruction 0920-1050 Webinar Webcast Workshop Survey
DSEPD Fellowship Webinar Customer Service Feedback Survey New 4000 480 0 Form and Instruction 0920-1050 DSEPD Fellowship Webinar Customer Service Feedback Survey
DSLR Tools and Resources Survey New 480 80 0 Form and Instruction 0920-1050 Tools or Resource Survey
DSLR Training Survey New 350 59 0 Form and Instruction 0920-1050 PIB Training Survey
Dating Matters Customer Satisfaction Survey New 567 67 0 Instruction
Form and Instruction 0920-1050 Online Survey - Interview Guide
Form and Instruction 0920-1050 Remote Interview Guide
Dating Matters Rebranding Research New 600 34 0 Form and Instruction 0920-1050 Dating Matters Rebranding Research
Other-Text
ETSB Customer Satisfaction Survey New 200 17 0 Form ETSB_2021_Cust_Sat_ Survey 0920-21HQ
Education and Training Services Branch Customer Satisfaction Survey New 200 17 0 Form none ETSB Customer Satisfaction Survey
Epidemiology Elective Program Alumni Survey New 680 113 0 Form none EEP Alumni Survey - word
Form none EEP Alumni Survey - screenshots
Evaluation of Spanish Webpages (CDC/DHDD) New 2250 271 0 Form and Instruction 0920-22DN Evaluation of the DHDD Spanish Websites Communication Materials
Evaluators' Network, Member Survey New 170 43 0 Form 0920-1050 2020 Annual Evaluators' Network Member Survey
Instruction
Evaluators' Network, Member Survey New 229 57 0 Form and Instruction 0920-1050 Network Member Survey
External Partner Discussion Groups to Inform Strategic Planning of CDC's Division of Laboratory Systems New 40 1 0 Form and Instruction 0920-22EV DLS External Partner Discussion Group 1-7
External Partner Focus Groups to Inform Strategic Planning of CDC's Division of Laboratory Systems New 20 30 0 Other-02_DLS External Partner Focus Groups 1&2 Guide_01-28-2022
Other-03_DLS External Partner Focus Group 3 Guide_01-28-2022
Other-04_DLS External Partner Focus Group 4 Guide_01-28-2022
Federal Select Agent Program Feedback Survey (FSAP) Survey New 247 41 0 Form 0920-21CR FSAP Survey
Feedback Survey for September 2021 Webinar New 400 34 0 Form and Instruction 0920-1050 Feedback Survey for 2021 Sept Webinar
Feedback interviews to improve technical assistance New 500 250 0 Other-WORD
Feedback on the use of the CDC Guideline for Prescribing Opioids for Chronic Pain. New 100 25 0 Form and Instruction 0920-20OP Online Feedback Opioid Guides
Feedback survey for Oct 2021 webinar (CDC/NIOSH/OD/ORI) New 400 34 0 Form and Instruction 0920-22AF NIOSH Foresight Friday Webinar
Feedback web-survey on forensic toxicology testing New 3618 922 0 Form and Instruction 0920-1050 Customer Feedback Forensic Toxicology
Other-Screenshot
Fundamentals of Working Safely in a Biological Safety Cabinet, Fundamentals of Chemical Fume Hood Safety, and Fundamentals of Centrifuge Safety CDC eLearning Courses Learner Feedback Survey New 2200 183 0 Form and Instruction 0920-1050 BSC / CFH / Centrifuge Learner Survey
IPP and FSAP Inspection Survey New 2264 755 0 Form and Instruction 0920-1050 Federal Select Agent Program (FSAP) and Import Permit Program (IPP) Inspection Survey
NCIPC Website Usability Testing New 400 133 0 Form none Usability Testing Instrument
Form none Screenshots
National Authority for Containment of Poliovirus 2020 Poliovirus Containment Webinar Participant Feedback Polling Questions and Survey New 200 50 0 Form and Instruction 0920-21BA US NAC Webinar Polling Questions
National Authority for Containment of Poliovirus Risk Mitigation Strategies Webinar Participant Feedback Polling Questions & Survey New 60 15 0 Other-Focus group guide
National Center for Injury Prevention and Control (NCIPC) Fellows & Interns' Evaluation New 200 17 0 Other-Screenshoot survey
Form and Instruction 0920-22EK Att. A NCIPC Fellowship and Internship Evaluation Feedback V3.4.18.22
OCIO Customer Satisfaction Survey 2020 New 2200 550 0 Form none Customer Satisfaction Survey 2020
OT18-1802: Strengthening Public Health Systems and Services Through National Partnerships to Improve and Protect the Nation's Health New 39 6 0 Form and Instruction 0920-1050 Survey Questionnaire
On-TAC Customer Service Survey New 480 80 0 Form and Instruction 0920-22EU Att1-On-TRAC Survey
Pilot Survey of the Applying CDC's Guidelines for Prescribing Opioids Online Training and Updated Post Course Evaluation New 100 17 0 Form and Instruction 3 Month Follow up Survey 0920-20LD
Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement New 40 6 0 Form 0920-1050 Post Site Visit Survey
Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement New 40 6 0 Form and Instruction 0920-1050 NAC Post-site Visit Survey
Preparedness Field Assignee Alumni Survey New 31 3 0 Form and Instruction 0920-1050 Preparedness Field Assignee Alumni Survey
Public Health Improvement Training (PHIT) Reaction Survey New 500 100 0 Form and Instruction 0920-1050 PHIT End of Session Survey - Web version
Form and Instruction 0920-1050 PHIT End of Training Survey - Web version
Public Health Improvement Training Attendee Reaction Survey New 300 25 0 Form none PHIT Survey - word
Form none PHIT Survey - web
Form none PHIT Survey - mobile
Public Health Improvement Training Attendee Reaction Survey New 480 40 0 Form and Instruction 0920-1050 Survey - word
Form and Instruction 0920-1050 Survey - web
Form and Instruction 0920-1050 Survey - mobile
Public Health Improvement Training Reaction Survey New 250 100 0 Other-WORD
Form and Instruction 0920-1050 NNPHI (Public Health Improvement Training Reaction Survey)
Other-WORD
Form and Instruction 0920-1050 NNPHI (PHIT End of Training Survey)
Instruction
Qualitative Feedback on External Training Provided by DSLR New 350 58 0 Form none Training Feedback
Qualitative Feedback on Preparedness Services Provided through DSLR's On-TRAC New 960 160 0 Form 0920-1050 On-TRAC Customer Feedback Survey
Qualitative Feedback on Tools and Resources Provided by DSLR New 480 80 0 Form none Tools and Resources Survey
Raising Healthy Boys: Communications Toolkit New 216 154 0 Other-WORD
Other-WORD
Registration and Feedback for the 2021 Place & Health Conference New 1120 43 0 Form and Instruction 0920-1050 Registration Form
Form and Instruction 0920-1050 Post Event Survey
SimpleReport Online Surveys New 200 7 0 Form 0920-1050 SimpleReport TouchPoint Survey
Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement New 500 167 0 Form and Instruction 0920-1050 Peer Reviewers Evaluation Form
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain New 360 660 0 Instruction
Other-WORD
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain New 200 300 0 Form and Instruction none Stakehold Engagement
Stakeholder Engagement and Feedback -Management of Acute and Chronic Pain New 360 660 0 Other-WORD
Other-WORD
Strategic Scholars Program Participant Feedback Survey New 37 6 0 Form and Instruction 0920-0879 Strategic Scholars Participant Survey
United States National Authority for the Containment of Polio (NAC) Webinar Survey and Polling Questions New 300 60 0 Form and Instruction 0920-1050 Webinar Polling Questions
United States National Authority for the Containment of Polio (NAC) Webinar Survey and Polling Questions New 300 60 0 Form 0920-1050 U.S. National Authority for the Containment of Polio Webinar Survey
Veto Violence Evaluation Y2 New 580 628 0 Other-WORD
Form 0920-1050 Violence Prevention in Practice
Other-WORD
Form and Instruction 0920-1050 Connection Selector Survey
VetoViolence Tools and Training Usability testing New 320 37 0 Form and Instruction 0920-1050 Invitation Email
Form and Instruction 0920-1050 Participation Survey
Form and Instruction 0920-1050 Follow-Up Email
Form and Instruction 0920-1050 Usability Testing Interview Guide - Veto Violence
Form and Instruction 0920-1050 Usability Testing Interview Guide - STRYVE
Violence Prevention Technical Assistance Center: Needs Assess New 524 112 0 Other-WORD
Other-WORD
WISQARS Data Visualization Mapping Usability Testing Customer Feedback New 36 42 0 Form and Instruction 0920-20QB Participant_Screener
Form and Instruction 0920-20QB Usability_Testing_Discussion_Guide
WISQARS Data Visualization Usability Testing Customer Feedback New 450 75 0 Form and Instruction n/a WISQARS User Survey
Website Usability Test for Division of Overdose Prevention Websites New 108 34 0 Form and Instruction 0920-1050 Individual Screener
Form and Instruction 0920-1050 Individual - Rx Awareness Moderator Guide
Form and Instruction 0920-1050 Individual - Marijuana Moderator Guide
Form and Instruction 0920-1050 Healthcare Provider Screener
Form and Instruction 0920-1050 Healthcare Provider - Drug Overdose Moderator Guide
Form and Instruction 0920-1050 Healthcare Provider - Acute Pain Moderator Guide
[2022, OD] CDC PRIME ReportStream Customer Experience feedback New 30 1 0 Form and Instruction None Help Improve ReportStream!
[2022] Select Adapt Evaluate - VetoViolence Usability Testing New 12 15 0 Form and Instruction None Recruitment Materials
Form and Instruction None Screening Form
Form and Instruction None Interview Scheduling
Form and Instruction None Consent and Interview Guide
[2022] VetoViolence Training and Resource Development - Health Equity New 1110 77 0 Form and Instruction None Interview Recruitment Materials
Form and Instruction None Interview Consent and Interview Guide
Form and Instruction None Survey Recruitment Materials
Form and Instruction None Survey Consent and Questionnaire
[CSELS DSEPD] CDC Fellowship Recruitment Event Feedback Survey (Nov 2021) New 1000 167 0 Form and Instruction n/a CDC Fellowship Recruitment Event Feedback Survey
Other-Survey content in WORD format to facilitate review
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 214949 20413 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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