[OPHDST] NBS 7 Transition User Assessment

[OS] CDC/ATSDR Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
Form 0920-25-0120 [OPHDST] NBS 7 Transition User Assessment Form
0920-25-0120 NBS 7 User Assesment NBS 7 Transition User Assessment Att A.docx Form
0920-1050 NBS 7 Transition User Assessment_New Requirements.docx New Requirements IC Document
0920-1050 NBS 7 Transition User Assessment_Approval Request.docx GenIC Request IC Document

Information Collection (IC) Details

IC Title:	[OPHDST] NBS 7 Transition User Assessment	Agency IC Tracking Number:	0920-25-0120

IC Status: New

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	0920-25-0120	NBS 7 User Assesment	NBS 7 Transition User Assessment Att A.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 72	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
New Requirements	0920-1050 NBS 7 Transition User Assessment_New Requirements.docx	08/13/2025
GenIC Request	0920-1050 NBS 7 Transition User Assessment_Approval Request.docx	08/13/2025

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