Information Collection

TRACIE Technical Assistance User Feedback Survey

IC 216769 under ICR 201504-0990-001 · OMB 0990-0391.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0391 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0391Attachment A TRACIE Technical Assistance Instrument 5.6.15.doc	Other-survey
0990-0391Attachment B TRACIE Program Customer Satisfaction Instrument 5.6.15.doc	Other-survey
0990-0391ASPR Generic- Short Supporting Statement- TRACIE 5 28 15.doc Technical Resources Assistance Center and Information Exchange (TRACIE)	IC Document

IC Title:

TRACIE Technical Assistance User Feedback Survey

Agency IC Tracking Number:

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-survey			0990-0391Attachment A TRACIE Technical Assistance Instrument 5.6.15.doc		Yes	Yes	Fillable Fileable
Other-survey			0990-0391Attachment B TRACIE Program Customer Satisfaction Instrument 5.6.15.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Technical Resources Assistance Center and Information Exchange (TRACIE)	0990-0391ASPR Generic- Short Supporting Statement- TRACIE 5 28 15.doc	05/28/2015

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