Information Collection

State and Community Awardee Project Director/Project Coordinator Needs Assessment

IC 203974 under ICR 201309-0920-010 · OMB 0920-0952.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0952 can be found here:

Documents and Forms

Document Name Document Type
State and Community Awardee Project Director/Project Coordinator Needs Assessment Form
New Web Survey Attachment 7 (web) State and Community Awardee Project Coordinator Project Director Needs Assessment.pdf Form
Attachment 7 (rev) State and Community Awardee Project Coordinator Project Director Needs Assessment.docx Paper-based Survey IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State and Community Awardee Project Director/Project Coordinator Needs Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	New Web Survey	Attachment 7 (web) State and Community Awardee Project Coordinator Project Director Needs Assessment.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9	9
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Paper-based Survey	Attachment 7 (rev) State and Community Awardee Project Coordinator Project Director Needs Assessment.docx	04/02/2013

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