State and Community Awardee Staff Needs Assessment

Process Evaluation of "Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through Community-Wide Initiatives"

Documents and Forms

Document Name Document Type
State and Community Awardee Staff Needs Assessment Form
new Web-based Survey Attachment 8 (web) State and Community Awardee Staff Needs Assessment.pdf Form
Attachment 8 (rev) State and Community Awardee Staff Needs Assessment.docx Survey -Word version IC Document

Information Collection (IC) Details

IC Title:	State and Community Awardee Staff Needs Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	none	new Web-based Survey	Attachment 8 (web) State and Community Awardee Staff Needs Assessment.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey -Word version	Attachment 8 (rev) State and Community Awardee Staff Needs Assessment.docx	04/02/2013

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