EBP/ETSC Administrator

Cross-Site Evaluation of the National Child Traumatic Stress Initiative (NCTSI)

Documents and Forms

Document Name Document Type
Form EBP/ETSC EBP/ETSC Administrator Form and Instruction
EBP/ETSC EBP/ETSC Attachment D.1_ETSC_Administrators.doc Form and Instruction

Information Collection (IC) Details

IC Title:	EBP/ETSC Administrator	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EBP/ETSC	EBP/ETSC	Attachment D.1_ETSC_Administrators.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 186	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	186	186
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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