Information Collection

Assessing Satisfaction with Training and Technical Assistance Provided to PICH and REACH Awardees

IC 221317 under ICR 201411-0920-012 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
4. Telephone Interview Protocol_042916.docx	Other-Telephone Survey
Training and Technical Assistance Survey Attachement E_Training and Technical Assistance Survey_FINAL for OMB 5-2-2016 ver 2.docx	Form
GenIC_DCH Training and TA_050216.docx Request for Approval	IC Document
1. Invitation email_031616.doc Invitation email	IC Document
2. Reminder email_031616.doc Reminder email	IC Document
5. Thank you email_031616.doc Thank you email	IC Document
3. SurveyScreenshots_050216_new3Line.docx Initial Screenshots	IC Document

IC Title:

Assessing Satisfaction with Training and Technical Assistance Provided to PICH and REACH Awardees

Agency IC Tracking Number:

16AHZ

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
Other-Telephone Survey			4. Telephone Interview Protocol_042916.docx		Yes	Yes	Fillable Fileable
Form	none	Training and Technical Assistance Survey	Attachement E_Training and Technical Assistance Survey_FINAL for OMB 5-2-2016 ver 2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

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: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	GenIC_DCH Training and TA_050216.docx	05/02/2016
Invitation email	1. Invitation email_031616.doc	05/02/2016
Reminder email	2. Reminder email_031616.doc	05/02/2016
Thank you email	5. Thank you email_031616.doc	05/02/2016
Initial Screenshots	3. SurveyScreenshots_050216_new3Line.docx	05/02/2016

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