Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Improving Processes for Identifying and Reporting Disaster-Related Deaths CDC Guidance Knowledge Assessment New 2871 529 0 Form and Instruction Survey 0920-22ID
Form and Instruction Focus Group Moderator Guide 0920-22ID
Pandemics, Natural Disasters, and other Interruption of Service Events: Contingency Planning Considerations for Mycobacteriology Testing New 116 126 0 Form and Instruction 0920-0879 Online Instrument
Form and Instruction 0920-0879 Focus Group Instrument
State, Tribal, Local, and Territorial PHIT Attendee Follow-up Survey New 525 26 0 Form and Instruction 0920-0879 State, Tribal, Local, and Territorial PHIT Attendee Follow-up Survey
[CSELS] Six-Month Follow-up Survey of PHIT Registrants from PH Agencies New 661 66 0 Other-WORD
Form and Instruction 0920-0879 Six-Month Follow-up Survey of PHIT Registrants from Public Health Agencies
[CSTLTS / NCEH] Exploration of CDC and WIC Partnerships for Childhood Lead Poisoning Prevention New 62 36 0 Form and Instruction None CLPPP-WIC Workgroup Interview Questions
[CSTLTS, NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States, 2022 – 2023 New 520 390 0 Form 0920-0879 Pediatric Hepatitis - MEDICAL RECORD ABSTRACTION FORM
Form 0920-0879 Pediatric Hepatitis - Exposure Questionnaire
Form 0920-0879 Pediatric Hepatitis - Exposure Questionnaire (Spanish)
Form 0920-0879 Pediatric Hepatitis - Exposure Questionnaire CONTROL
Form 0920-0879 Pediatric Hepatitis - Exposure Questionnaire CONTROL (Spanish)
[CSTLTS] ATSDR Public Health Surveillance Stakeholder Input and Priorities New 90 32 0 Form and Instruction n/a ATSDR Stakeholder Survey to Determine Surveillance Needs
[CSTLTS] Assessing Outcomes of the CDC-Harvard Program Evaluation Practicum in Building Program Evaluation Capacity in STLT Maternal and Child Health Programs (2023) New 241 108 0 Form and Instruction None Training Feedback from 2023 MCH Program Participants (3-Month Survey)
Form and Instruction None Training Feedback from 2023 MCH Program Participants (3-Month Survey) (screen shots)
Form and Instruction None Progress of Evaluation Implementation from 2023 CDC Harvard Practicum Participants (6-Month Survey)
Form and Instruction None Progress of Evaluation Implementation from 2023 CDC Harvard Practicum Participants (6-Month Survey) (screen shots)
Form and Instruction None Evaluation Progress and Capacity Assessment among 2023 CDC Harvard Practicum Participants (12-Month Survey)
Form and Instruction None Evaluation Progress and Capacity Assessment among 2023 CDC Harvard Practicum Participants (12-Month Survey) (screen shots)
Form and Instruction None Evaluation Progress and Capacity Building among Participants from the 2023 CDC Harvard Practicum (12-Month Interview)
Form and Instruction None Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022) (SURVEY)
Form and Instruction None Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022) (SURVEY) (screen shots)
Form and Instruction None Evaluation Capacity and Practicum Experience among Past Practicum Participants (2018-2022) (INTERVIEW)
[CSTLTS] Disease Intervention Specialist (DIS) Workforce Assessment New 491 985 0 Form and Instruction 0920-0879 Disease Intervention Professional Enumeration Study (Local)
Form and Instruction 0920-0879 Disease Intervention Professional Enumeration Study (State & Territorial)
[CSTLTS] Early Care and Education (ECE) State Indicator Assessment 2022 New 51 20 0 Form and Instruction None Early Care and Education (ECE) 2022 State Indicator Assessment
Other-WORD version of survey content to facilitate review
[CSTLTS] Emergency Response and Planning Time Motion Study Data Collection New 58 261 0 Form and Instruction 0920-0879-23EX Attachment A- Participant Exercise Overview Form
Form and Instruction 0920-0879-23EX Attachment B- Time Motion Data Collection Excel
[CSTLTS] National Syndromic Surveillance System Program's BioSense Platform Assessment, 2023 New 541 84 0 Form and Instruction None NSSP BioSense Platform User Assessment, 2023
Other-WORD version of user survey content to facilitate review
Form and Instruction None NSSP BioSense Platform User Assessment for Site Administrators, 2023
Other-WORD version of site administrator survey content to facilitate review
[CSTLTS] OT21-23 Success Stories New 1080 6660 0 Form and Instruction 0920-23EV Attachment C_OT21-2103 Success Stories Form- Word
[CSTLTS] Pilot Reporting of Cancer Inquiries by the Public to STLT Partners New 580 117 0 Form and Instruction n/a Cancer Intake Inquiry Form - Redcap
Form and Instruction n/a Cancer Intake Inquiry Form - EpiInfo
Form and Instruction n/a Annual Report of Cancer Inquiries to STLTs
[CSTLTS] Six-Month Follow-up Survey of PHIT Registrants from PH Agencies New 661 66 0 Other-WORD
Form 0920-0879 Six-Month Follow-up Survey of PHIT Registrants from PH Agencies
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 8548 9506 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title