Information Collection Request

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

ICR 201612-0920-007 · OMB 0920-1009 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1009 Preventing Adverse Childhood Experiences Pediatric Medical Provider Module Online Course Form and Instruction New Available
Form 0920-1009 Recipient Meeting Participant's Feedback - Division of Violence Prevention Form and Instruction New Available
WISQARS Data Visualization Usability Testing Customer Feedback Form New Available
Form 0920-1009 Bullying Prevention Online Course –Evaluation Questions - Course Specific Form and Instruction New Available
Form 0920- 17AV Website Usability Testing Customer Feedback. DVP Form and Instruction New Available
Form 0920-17AQJ Division of Violence Prevention web-based Technical assistance Participant's Feedback Form and Instruction New Available
Att D. Instrument_GenIC_RequestTemplate.docx Supplementary Document Uploaded 2016-12-12 Available
SSB_ OMB-1009 - Servie Delivery_NCIPC.docx Supporting Statement B Uploaded 2016-12-12 Available
SSA_0920-1009_021317_v2.docx Supporting Statement A Uploaded 2017-02-13 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/29/2020 36 Months From Approved 03/31/2017
61,920 0 228,000
18,315 0 104,250
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 61,920 228,000 0 -166,080 0 0
Annual Time Burden (Hours) 18,315 104,250 0 -85,935 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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