GenIC XDRCI-COST

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Attachment_B_Introduction_to_the_TB_controller_and_solicitation_of_data_....docx Instruction
Attachment_Ca_Data_Collection_instructions.docx Instruction
Attachment_Cb_State_and_county_representative_data_collection_spreadshee....xlsx Other-Excel
Attachment_Da_Information_transmitting_interview_guide_instrument_progra....docx Instruction
Attachment_Db_Information_transmitting_interview_guide_instrument_accoun....docx Instruction
Attachment_E_Phone_script_followup_instrument.docx Other-WORD
XDRCI-COST-SSA.DOCX Sup Sta A IC Document
XDRCI-COST-SSB.DOCX Sup Sta B IC Document
Attachment_A_State_and_county_collaborators.docx Att A_ State and County Collaborators IC Document
Attachment_F_Notification_Email_to_TB_Controller.docx Att F_Notification Email to TB Controller IC Document
Attachment_G_Notification_Email_to_Respondent.docx Att G_Notification Email to Respondent IC Document
Attachment_H_Reminder_email.docx Att H_Reminder Email IC Document
Attachment_I_Email_to_set_up_validation_call.docx Att I_Email to Set-Up Validation Call IC Document

Information Collection (IC) Details

IC Title:	GenIC XDRCI-COST	Agency IC Tracking Number:	16AVZ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Instruction	Attachment_B_Introduction_to_the_TB_controller_and_solicitation_of_data_....docx	No	Paper Only
Instruction	Attachment_Ca_Data_Collection_instructions.docx	No	Paper Only
Other-Excel	Attachment_Cb_State_and_county_representative_data_collection_spreadshee....xlsx	No	Fillable Fileable
Instruction	Attachment_Da_Information_transmitting_interview_guide_instrument_progra....docx	No	Paper Only
Instruction	Attachment_Db_Information_transmitting_interview_guide_instrument_accoun....docx	No	Paper Only
Other-WORD	Attachment_E_Phone_script_followup_instrument.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sup Sta A	XDRCI-COST-SSA.DOCX	07/22/2016
Sup Sta B	XDRCI-COST-SSB.DOCX	07/22/2016
Att A_ State and County Collaborators	Attachment_A_State_and_county_collaborators.docx	07/22/2016
Att F_Notification Email to TB Controller	Attachment_F_Notification_Email_to_TB_Controller.docx	07/25/2016
Att G_Notification Email to Respondent	Attachment_G_Notification_Email_to_Respondent.docx	07/25/2016
Att H_Reminder Email	Attachment_H_Reminder_email.docx	07/25/2016
Att I_Email to Set-Up Validation Call	Attachment_I_Email_to_set_up_validation_call.docx	07/25/2016

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