Technical Packages for Violence Prevention Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey

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⚠️ Notice: This information collection may be referencing outdated material.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
Technical Packages for Violence Prevention Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey Form
Technical Package Violence Prevention Survey Att. B DVP Screenshot.docx Form
Request GenIc1050 DVP Technical Packages.docx Request for Approval IC Document
Att. A Instrument DVP TP.docx Survey - Word IC Document

Information Collection (IC) Details

IC Title:	Technical Packages for Violence Prevention Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey	Agency IC Tracking Number:	17SK

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	Technical Package Violence Prevention Survey	Att. B DVP Screenshot.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 861	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	861	861
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Request GenIc1050 DVP Technical Packages.docx	02/13/2017
Survey - Word	Att. A Instrument DVP TP.docx	02/13/2017

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