Online Survey Instrument

[NCHHSTP] CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis Drug Susceptibility Testing

Documents and Forms

Document Name Document Type
Online Survey Instrument Form and Instruction
Online Survey Instrument Webshots Att. 4-Online Survey Instrument Webshots.docx Form and Instruction
PDF of Online Survey Instrument.pdf PDF Online Survey Instrument IC Document

Information Collection (IC) Details

IC Title:	Online Survey Instrument	Agency IC Tracking Number:	0920-0600

Is this a Common Form? No		IC Status: Modified

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	n/a	Online Survey Instrument Webshots	Att. 4-Online Survey Instrument Webshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	140	-20	160
Annual IC Time Burden (Hours)	35	-5	40
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
PDF Online Survey Instrument	PDF of Online Survey Instrument.pdf	09/04/2025

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