Assessment Branch (AB) Partner Data Assessment Project

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

Documents and Forms

Document Name Document Type
Attachment A - Key Informant Interview Guide.docx Other-WORD
Attachment B - Interview Scheduling Email.docx Att B - Interview Scheduling Email IC Document
Attachment C - Interview Confirmation Email.docx Att C _ Interview Confirmation Email IC Document
Fast_Track_GenIC_Request Partner Data Assessment Project_final.docx Request for Approval - Customer Feedback IC Document

Information Collection (IC) Details

IC Title:	Assessment Branch (AB) Partner Data Assessment Project	Agency IC Tracking Number:	14AUM

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			Attachment A - Key Informant Interview Guide.docx		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att B - Interview Scheduling Email	Attachment B - Interview Scheduling Email.docx	08/14/2014
Att C _ Interview Confirmation Email	Attachment C - Interview Confirmation Email.docx	08/14/2014
Request for Approval - Customer Feedback	Fast_Track_GenIC_Request Partner Data Assessment Project_final.docx	08/14/2014

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