Information Collection

Recovery to Pratice Resource Center TA and Webinar Evaluation Form

IC 192282 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⚠️ Notice: This information collection may be referencing outdated material.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 TA Evaluation Form Recovery to Pratice Resource Center TA and Webinar Evaluation Form	Form and Instruction
TA Evaluation Form TA Evaluation Form Attachment A Technical Assistance Evaluation Form FINAL.doc	Form and Instruction
Webinar Evaluation Webinar Evaluation Form Attachment B Webinar Evaluation Form FINAL.doc	Form and Instruction
OMB TA Evaluation Form Justification FINAL.doc Supporting Statement	IC Document
OMBTransLet11-2010.wpd Memo	IC Document

IC Title:

Recovery to Pratice Resource Center TA and Webinar Evaluation Form

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	TA Evaluation Form	TA Evaluation Form	Attachment A Technical Assistance Evaluation Form FINAL.doc		No	No	Paper Only
Form and Instruction	Webinar Evaluation Form	Webinar Evaluation Form	Attachment B Webinar Evaluation Form FINAL.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,880

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

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	1,880	0	0	0	0	0
Annual IC Time Burden (Hours)	156	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
Supporting Statement	OMB TA Evaluation Form Justification FINAL.doc	03/08/2010
Memo	OMBTransLet11-2010.wpd	03/08/2010

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