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

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.