State/Local/Tribal Evaluation Lead

DCH Awardee Training Needs Assessment

Documents and Forms

Document Name Document Type
State/Local/Tribal Evaluation Lead Form
Training Needs Assessment Attachment I_Screen Shots_rev6-26-15 clean.docx Form

Information Collection (IC) Details

IC Title:	State/Local/Tribal Evaluation Lead	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	none	Training Needs Assessment	Attachment I_Screen Shots_rev6-26-15 clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	41	41
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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