Information Collection

Customer Feedback of state-level traumatic brain injury prevention workers

IC 213822 under ICR 201405-0920-002 · OMB 0920-1009.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.