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Radiation Dose Tool Feedback
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0923-0047
IC ID: 216345
OMB.report
HHS/TSDR
OMB 0923-0047
ICR 201305-0923-003
IC 216345
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:
2021-11-16 - Revision of a currently approved collection
2018-11-27 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
ATT C RDT Public Screener.docx
Other-Telephone Screener
ATT F RDT Interview Guide for Public.docx
Other-Interview Guide
ATT D RDT PIO and Public Planners Screener.docx
Other-Telephone Screener
ATT G RDT Interview Guide for Public Health.docx
Other-Interview Guide
Appendix H Radiation Dose Tool.pptx
Radiation Dose Tool
IC Document
ATT A RDT Protocol Summary.docx
RDT Protocol Summary
IC Document
ATT B RDT Protocol.docx
RDT Protocol
IC Document
ATT E Participant Info Sheet.docx
Participant Info Sheet
IC Document
Request for Service Delivery GenIC 0923-0047 Radiation Dose Tool.pdf
Request for Approval
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Radiation Dose Tool Feedback
Agency IC Tracking Number:
15AFB
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
Other-Telephone Screener
ATT C RDT Public Screener.docx
Yes
Yes
Fillable Printable
Other-Interview Guide
ATT F RDT Interview Guide for Public.docx
No
Paper Only
Other-Telephone Screener
ATT D RDT PIO and Public Planners Screener.docx
Yes
Yes
Fillable Printable
Other-Interview Guide
ATT G RDT Interview Guide for Public Health.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
108
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
50 %
Approved
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
108
0
108
0
0
0
Annual IC Time Burden (Hours)
48
0
48
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Radiation Dose Tool
Appendix H Radiation Dose Tool.pptx
04/29/2015
RDT Protocol Summary
ATT A RDT Protocol Summary.docx
04/29/2015
RDT Protocol
ATT B RDT Protocol.docx
04/29/2015
Participant Info Sheet
ATT E Participant Info Sheet.docx
04/29/2015
Request for Approval
Request for Service Delivery GenIC 0923-0047 Radiation Dose Tool.pdf
04/29/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.