GDTA Survey

Grantee Data Technical Assistance Training Needs Assessment Survey

Documents and Forms

Document Name Document Type
Form GDTA Survey GDTA Survey Form and Instruction
GDTA Survey GDTA Survey GDTA Attachment A 12-18-14.docx Form and Instruction
GDTA Attachment B 12-18-14.docx Email Invitation to Project Directors IC Document
GDTA Attachment C 12-18-14.docx Screen Shots IC Document

Information Collection (IC) Details

IC Title:	GDTA Survey	Agency IC Tracking Number:

Is this a Common Form? No		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
Form and Instruction	GDTA Survey	GDTA Survey	GDTA Attachment A 12-18-14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,670	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,670	2,670
Annual IC Time Burden (Hours)	267	267
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email Invitation to Project Directors	GDTA Attachment B 12-18-14.docx	03/25/2015
Screen Shots	GDTA Attachment C 12-18-14.docx	03/25/2015

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