Information Collection

Directors

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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.