[CGH] Shiriki Virtual Community Annual Planning Survey

[OADC] CDC Usability and Digital Content Testing

Documents and Forms

Document Name Document Type
Form 0920-1050 [CGH] Shiriki Virtual Community Annual Planning Survey Form and Instruction
0920-1050 Shiriki Protocol New Member_Webinar Feedback Form Protocol_Shiriki community_Nov 2023.docx Form and Instruction
0920-1050_Shiriki annual community annual survey.docx 0920-1050 GenIC Request Template IC Document

Information Collection (IC) Details

IC Title:	[CGH] Shiriki Virtual Community Annual Planning Survey	Agency IC Tracking Number:	0920-1050-24CJ

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	0920-1050	Shiriki Protocol New Member_Webinar Feedback Form	Protocol_Shiriki community_Nov 2023.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0920-1050 GenIC Request Template	0920-1050_Shiriki annual community annual survey.docx	01/24/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.