Information Collection

Impact of Training and Technical Assistance Tool

IC 213726 under ICR 201406-0930-006 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TTA Tool Impact of Training and Technical Assistance Tool	Form and Instruction
TTA Tool TTA Tool Attachment 1-TA Network_QA Survey.docx	Form and Instruction
Attachment 3-IRB Determination Letter.pdf IRB	IC Document
TA Network Supporting Statement CQI Final.docx Supporting Statement	IC Document
Trans.Let-3-2014.doc Transmittal Letter	IC Document

IC Title:

Impact of Training and Technical Assistance Tool

Agency IC Tracking Number:

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	TTA Tool	TTA Tool	Attachment 1-TA Network_QA Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	800	800
Annual IC Time Burden (Hours)	136	136
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IRB	Attachment 3-IRB Determination Letter.pdf	11/04/2014
Supporting Statement	TA Network Supporting Statement CQI Final.docx	11/04/2014
Transmittal Letter	Trans.Let-3-2014.doc	11/04/2014

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