Customer Feedback of state-level traumatic brain injury prevention workers

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1009 can be found here:

Documents and Forms

Document Name Document Type
Customer Feedback of state-level traumatic brain injury prevention workers Form and Instruction
TBI Small Group Discussion Protocol Instrument_GenIC_1009_CustFeedbTBI.docx Form and Instruction
Request_GenIC_1009_CustFeedbackTBI.docx Request for Approval IC Document
Email invite_final 2014_11_17.docx Email Invitation IC Document

Information Collection (IC) Details

IC Title:	Customer Feedback of state-level traumatic brain injury prevention workers	Agency IC Tracking Number:	15EB

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	none	TBI Small Group Discussion Protocol	Instrument_GenIC_1009_CustFeedbTBI.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	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	35	35
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Request_GenIC_1009_CustFeedbackTBI.docx	11/12/2014
Email Invitation	Email invite_final 2014_11_17.docx	11/17/2014

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