[NCIRD] DEIA Mentorship Program

[OADC] CDC Usability and Digital Content Testing

Documents and Forms

Document Name Document Type
Form 0920-1050 [NCIRD] DEIA Mentorship Program Form and Instruction
0920-1050 DEIA Mentorship Program Post Program DEIA Mentorship Program POST Program.docx Form and Instruction
0920-1050 DEIA Mentorship Program Pre Program DEIA Mentorship Program PRE Program.docx Form and Instruction
0920-1050_NCIRD DEIA Mentorship Program.docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-105 IC Document

Information Collection (IC) Details

IC Title:	[NCIRD] DEIA Mentorship Program	Agency IC Tracking Number:	0920-1050-24JC

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	DEIA Mentorship Program Post Program	DEIA Mentorship Program POST Program.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	DEIA Mentorship Program Pre Program	DEIA Mentorship Program PRE Program.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	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	30	30
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1050)	0920-1050_NCIRD DEIA Mentorship Program.docx	10/09/2024

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