Information Collection

State and Community Awardee Training and Technical Assistance Reporting Form

IC 203976 under ICR 201409-0920-009 · OMB 0920-0952.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form no State and Community Awardee Training and Technical Assistance Reporting Form	Form
no State and Community Awardee Training and Technical Assis Attachment 9. State and Community Awardee Training and Technical Assistance Tool.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	no	State and Community Awardee Training and Technical Assistance Reporting Form	Attachment 9. State and Community Awardee Training and Technical Assistance Tool.docx		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: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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