Information Collection

Child Adolescent and Family Branch Technical Assistance Feedback Surveys

IC 197384 under ICR 201103-0930-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Surveys Child Adolescent and Family Branch Technical Assistance Feedback Surveys	Form and Instruction
Surveys Surveys Contractor Satisfaction Surveys List of Attachments, 3-8-11.pdf	Form and Instruction
Surveys Surveys Contractor Satisfaction Surveys List of Attachments, 5-31-11.pdf	Form and Instruction
Contractor Justification 3-8-11.doc Justification	IC Document
Trans.Let-1-2011.doc Letter	IC Document
Contractor Satisfaction Surveys, 5-31-11.pdf Supporting Statement	IC Document

IC Title:

Child Adolescent and Family Branch Technical Assistance Feedback Surveys

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	Surveys	Surveys	Contractor Satisfaction Surveys List of Attachments, 3-8-11.pdf		Yes	Yes	Paper Only
Form and Instruction	Surveys	Surveys	Contractor Satisfaction Surveys List of Attachments, 5-31-11.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 880

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	880	0	0	0	0	0
Annual IC Time Burden (Hours)	126	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	Contractor Justification 3-8-11.doc	03/08/2011
Letter	Trans.Let-1-2011.doc	03/08/2011
Supporting Statement	Contractor Satisfaction Surveys, 5-31-11.pdf	05/31/2011

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