Feedback for 2018 Place & Health Conference

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1050 Feedback for 2018 Place & Health Conference Form and Instruction
0920-1050 Feedback for 2018 Place & Health Conference Attachment B_Screenshot of Event Feedback Form.docx Form and Instruction
Attachment C_Email with survey.docx Email / Survey Information IC Document
GenIC Feedback 2018 Pace and Health Conference-OSsigned.pdf GenIC Request IC Document
NCEH-ATSDR Research Determination Form Signed OS.pdf Research Determination IC Document

Information Collection (IC) Details

IC Title:	Feedback for 2018 Place & Health Conference	Agency IC Tracking Number:	0920-1050-19AZ

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	0920-1050	Feedback for 2018 Place & Health Conference	Attachment B_Screenshot of Event Feedback Form.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email / Survey Information	Attachment C_Email with survey.docx	10/15/2018
GenIC Request	GenIC Feedback 2018 Pace and Health Conference-OSsigned.pdf	10/15/2018
Research Determination	NCEH-ATSDR Research Determination Form Signed OS.pdf	10/15/2018

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