OMB
.report
Search
[NCCDPHP] My Family Health Portrait Cancer mobile application
[OADC] CDC Usability and Digital Content Testing
OMB: 0920-1050
IC ID: 260592
OMB.report
HHS/CDC
OMB 0920-1050
ICR 202505-0920-006
IC 260592
( )
Documents and Forms
Document Name
Document Type
Att 1_Mobile app evaluation questions.docx
Other-WORD
0920-1050 Family Health Profiles
Att 2_Screenshots of DCPC MFHP_In_App_Feedback.docx
Form
Customer Service GenIC Clearance Template_MFHP Cancer_June 2023.docx
Customer Feedback on My Family Health Portrait: Cancer Mobile Application
IC Document
0920-1050_Supporting Statement A_MFHP Cancer_June 2023.docx
0920-1050 SSA
IC Document
0920-1050_Supporting Statement B_MFHP Cancer.docx
0920-1050 SSB
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
[NCCDPHP] My Family Health Portrait Cancer mobile application
Agency IC Tracking Number:
0920-1050-23EI
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
Other-WORD
Att 1_Mobile app evaluation questions.docx
No
Paper Only
Form
0920-1050
Family Health Profiles
Att 2_Screenshots of DCPC MFHP_In_App_Feedback.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
1,200
0
0
0
0
1,200
Annual IC Time Burden (Hours)
10
0
0
0
0
10
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Customer Feedback on My Family Health Portrait: Cancer Mobile Application
Customer Service GenIC Clearance Template_MFHP Cancer_June 2023.docx
06/14/2023
0920-1050 SSA
0920-1050_Supporting Statement A_MFHP Cancer_June 2023.docx
06/14/2023
0920-1050 SSB
0920-1050_Supporting Statement B_MFHP Cancer.docx
06/09/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.