GenIC Division of Violoence Prevention Webinar Participant Feedback

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⚠️ Notice: This information collection may be referencing outdated material.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
Att 1_Webinar Feedback Form.docx Other-WORD
Att 2_Invitation Email.docx Att 2_ Invitation Email IC Document
Att 3_Reminder Email.docx Att 3_Reminder Email IC Document
Att 4_Listerv Announcement.docx Att 4_Listserv Announcement Email IC Document
Service Orien GenIC Request_DVP Webinar Participant Feedback_72616KA.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	GenIC Division of Violoence Prevention Webinar Participant Feedback	Agency IC Tracking Number:	16AWI

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
Other-WORD			Att 1_Webinar Feedback Form.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	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	800	800
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 2_ Invitation Email	Att 2_Invitation Email.docx	08/01/2016
Att 3_Reminder Email	Att 3_Reminder Email.docx	08/01/2016
Att 4_Listserv Announcement Email	Att 4_Listerv Announcement.docx	08/01/2016
Request for Approval	Service Orien GenIC Request_DVP Webinar Participant Feedback_72616KA.docx	08/01/2016

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