Information Collection

Peer Workers Survey

IC 213440 under ICR 201410-0930-002 · OMB 0930-0345.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Core Competency Su Core Competency Survey Peer Workers Survey	Form
Core Competency Su Core Competency Survey Attachment 1 Core competency survey.docx	Form
Attachment 3 Data Collection Protocols.docx Data Collection Protocols	IC Document
Attachment 4 Letter to Survey Participants.docx Letter to Survey Participants	IC Document

IC Title:

Peer Workers Survey

Agency IC Tracking Number:

Is this a Common Form? No

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	Core Competency Survey				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	100	100
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Data Collection Protocols		10/09/2014
Letter to Survey Participants		10/09/2014

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

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