Information Collection Request

RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { border-color: transparent; background-color: transparent; left: 250px; top:75px; width:1px; height:1px; color:black; overflow:hid

ICR 202101-0920-015 · OMB 0920-1327 · RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b

Forms and Documents

Document Name	Status
Form 0920-20QJ Critical Item Survey Form and Instruction	New
Form 0920-20QJ Main Questionnaire Form and Instruction	New
Attachment 12 -Privacy impact assessment form.pdf Supplementary Document	2021-01-26
Attachment 11_ Human subjects document non-research determination.pdf Supplementary Document	2021-01-26
Attachment 10_Privacy Narrative.pdf Supplementary Document	2021-01-26
Attachment 7 - Telephone contacting scripts.docx Supplementary Document	2021-01-26
Attachment 6d_Last chance email.docx Supplementary Document	2021-01-26
Attachment 6c_SAQ cover letter.docx Supplementary Document	2021-01-26
Attachment 6b_Reminder email template.docx Supplementary Document	2021-01-26
Attachment 6a_Email invitation.docx Supplementary Document	2021-01-26
Attachment 5b - Frequently asked questions.docx Supplementary Document	2021-01-26
Attachment 5a_Survey invitation letter.docx Supplementary Document	2021-01-26
Attachment 4_Prenotification letter.docx Supplementary Document	2021-01-26
Attachment 2a - 60-Day Federal Register Notice.pdf Supplementary Document	2021-01-26
Attachment 1_Public Health Service Act [42 U.S.C. 241].pdf Supplementary Document	2021-01-26
OMB Supporting Statement B.docx Supporting Statement B	2021-01-26
OMB Supporting Statement A final.docx Supporting Statement A	2021-01-26

IC Document Collections

IC ID	Document Title	Status
245435	Critical Item Survey Form and Instruction	New
245433	Main Questionnaire Form and Instruction	New

ICR Details

Status	RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b
Agency/Subagency	RegInfo.gov Technical Difficulties focusMethod =
OMB Control No	0920-1327
Type of Information Collection	RegInfo.gov Technical Difficulties focusMethod = function getFocus() { document.getElementById("main").focus(); } .skip-main { b
Previous ICR Reference No	RegInfo.gov Technical Difficulties focusMethod =
Agency Tracking No	RegInfo.gov Technical Difficulties focusMethod =
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31