Information Collection

Directors

IC 197693 under ICR 201105-0930-002 · OMB 0930-0327.

Documents and Forms

Document Name Document Type
Form Attachment C_Follo Directors Form and Instruction
Attachment A_Basel Attachment A_Baseline Survey Director Attachment A_Baseline Survey, Director Version_Final_with OMB changes.doc Form and Instruction
Attachment C_Follo Attachment C_Followup Survey Director Attachment C_Followup Survey, Director Version_Final_with OMB changes.doc Form and Instruction
Attachment E_Evalu Attachment E_Evaluation Survey_Packets_Final_with OMB ch Attachment E_Evaluation Survey_Packets_Final_with OMB changes.doc Form and Instruction
Attachment F_Evalu Attachment F_Evaluation Survey_Training Webinar_Final_wi Attachment F_Evaluation Survey_Training Webinar_Final_with OMB changes.doc Form and Instruction
Attachment G_Evalu Attachment G_Evaluation Survey_Coaching Webinar_Final_wi Attachment G_Evaluation Survey_Coaching Webinar_Final_with OMB changes.doc Form and Instruction
Attachment H_Copy of Survey Screen.docx Attachment H_Copy of Survey Screen IC Document
Attachment I_Email Correspondence to Participants_Final.doc Attachment I_Email Correspondence to Participants IC Document
Attachment J_IRB Letter of Approval.pdf Attachment J_IRB Letter of Approval IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Directors	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment C_Followup Survey Director	Attachment C_Followup Survey Director	Attachment C_Followup Survey, Director Version_Final_with OMB changes.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment E_Evaluation Survey_Packets_Final_with	Attachment E_Evaluation Survey_Packets_Final_with OMB changes	Attachment E_Evaluation Survey_Packets_Final_with OMB changes.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment F_Evaluation Survey_Training Webinar_Fi	Attachment F_Evaluation Survey_Training Webinar_Final_with OMB changes	Attachment F_Evaluation Survey_Training Webinar_Final_with OMB changes.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment G_Evaluation Survey_Coaching Webinar_Fi	Attachment G_Evaluation Survey_Coaching Webinar_Final_with OMB changes	Attachment G_Evaluation Survey_Coaching Webinar_Final_with OMB changes.doc	Yes	Yes	Paper Only
Form and Instruction	Attachment A_Baseline Survey Director	Attachment A_Baseline Survey Director	Attachment A_Baseline Survey, Director Version_Final_with OMB changes.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	184	184
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment H_Copy of Survey Screen	Attachment H_Copy of Survey Screen.docx	05/03/2011
Attachment I_Email Correspondence to Participants	Attachment I_Email Correspondence to Participants_Final.doc	05/03/2011
Attachment J_IRB Letter of Approval	Attachment J_IRB Letter of Approval.pdf	05/03/2011

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