View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Shigella Hypothesis Generating Questionnaire 0920-20HD
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None SHGQ Interviewer-administered (English) with FALL 2022 changes Appendix D. SHGQ_English_Health Department Phone_UPDATED_08.02.2022.docx Yes Yes Fillable Fileable
Form and Instruction None SHGQ Interviewer-administered (Spanish) with FALL 2022 changes Appendix E. SHGQ_Spanish_Health Department Phone_FINAL_08.03.2022.docx Yes Yes Fillable Fileable
Form and Instruction None SHGQ Self-administered Web Survey (English) with FALL 2022 changes Appendix G. SHGQ_English_Web.pdf Yes Yes Fillable Fileable
Form and Instruction None SHGQ Self-administered Web Survey (Spanish) with FALL 2022 changes Appendix E. SHGQ_Spanish_Web.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,500 0
   
Individuals or Households
 
   90 %

  Approved 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 1,500 0 0 0 0 1,500
Annual IC Time Burden (Hours) 1,125 0 0 0 0 1,125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Edited content for the Self-administered Web Survey (English) Appendix G. SHGQ_English_Web_TRACK_08.02.2022.docx 09/01/2022
Edited content for the Self-administered Web Survey (Spanish) Appendix H. SHGQ_Spanish_Web_FINAL_08.02.2022.docx 09/01/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.