Information Collection

CMHS-GPRA Satisfaction of Technical Assistance Survey

IC 190367 under ICR 200710-0930-001 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Screen Shots CMHS-GPRA Satisfaction of Technical Assistance Survey	Form and Instruction
Screen Shots Screen Shots CMHS-TRAC TA Annual Survey Final Screen Shot 7-30-09.doc	Form and Instruction
Attachment A - Onl Attachment A - Online User's Survey CMHS-TRAC TA Annual Survey Final 7-30-09.doc	Form and Instruction
CMHS-TRAC TA Survey OMB Request Final 7-30-09.doc Justification	IC Document
OMBTransLet8-2009.wpd Memo	IC Document

IC Title:

CMHS-GPRA Satisfaction of Technical Assistance Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Screen Shots	Screen Shots	CMHS-TRAC TA Annual Survey Final Screen Shot 7-30-09.doc		Yes	Yes	Paper Only
Form and Instruction	Attachment A - Online User's Survey	Attachment A - Online User's Survey	CMHS-TRAC TA Annual Survey Final 7-30-09.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	800	0	0	0	0	0
Annual IC Time Burden (Hours)	128	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	CMHS-TRAC TA Survey OMB Request Final 7-30-09.doc	07/30/2009
Memo	OMBTransLet8-2009.wpd	07/30/2009

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