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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
COVID-19 Attitudes and Beliefs Survey (CABS)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
Attachment A
Attachment A: COVID-19 Attitudes and Beliefs Survey (CABS) – Questionnaire
Part A_Attachment A_COVID-19 Attitudes and Beliefs_Questionnaire.docx
Yes
Yes
Fillable Fileable
Form and Instruction
Attachment B
Attachment B: COVID-19 Attitudes and Beliefs Survey – NORC Consent Form
Part A_Attachment B_COVID-19 Attitudes and Beliefs Survey_NORC Consent Form.docx
Yes
Yes
Fillable Fileable
Form and Instruction
Attachment C
Attachment C: COVID-19 Attitudes and Beliefs Survey – Communications
Part A_Attachment C_COVID-19 Attitudes and Beliefs Survey_Communications.docx
Yes
Yes
Fillable Fileable
Other-CABS survey-Wave2
ASPA_OutcomeEval_AQ_Wave2_V2_clean.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
12,000
0
0
0
0
12,000
Annual IC Time Burden (Hours)
6,960
0
0
0
0
6,960
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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