Information Collection

Division of Violence Prevention web-based Technical assistance Participant's Feedback

IC 227244 under ICR 201612-0920-007 · OMB 0920-1009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-17AQJ Division of Violence Prevention web-based Technical assistance Participant's Feedback	Form and Instruction
0920-17AQJ Att 1_Webinar Feedback Form_May_2017 Att 1_Webinar Feedback Form_May_2017.docx	Form and Instruction
109_GenIC_Request_Webinar Participant Feedback_2017F.docx 109_GenIC_Request_Webinar Participant Feedback_2017F	IC Document
Att 2_DVP Webinar Feedback Form Invitation Email_May 2017.docx Att 2_DVP Webinar Feedback Form Invitation Email_May 2017	IC Document
Att 3_DVP Webinar Feedback Form Reminder Email_May 2017.docx Att 3_DVP Webinar Feedback Form Reminder Email_May 2017	IC Document
Att 4_DVP Webinar Feedback Form Listerv Announcement_May 2017.docx Att 4_DVP Webinar Feedback Form Listerv Announcement_May 2017	IC Document

IC Title:

Agency IC Tracking Number:

0920-17AQJ

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
Form and Instruction	0920-17AQJ	Att 1_Webinar Feedback Form_May_2017	Att 1_Webinar Feedback Form_May_2017.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	800	800
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
109_GenIC_Request_Webinar Participant Feedback_2017F	109_GenIC_Request_Webinar Participant Feedback_2017F.docx	06/20/2017
Att 2_DVP Webinar Feedback Form Invitation Email_May 2017	Att 2_DVP Webinar Feedback Form Invitation Email_May 2017.docx	06/20/2017
Att 3_DVP Webinar Feedback Form Reminder Email_May 2017	Att 3_DVP Webinar Feedback Form Reminder Email_May 2017.docx	06/20/2017
Att 4_DVP Webinar Feedback Form Listerv Announcement_May 2017	Att 4_DVP Webinar Feedback Form Listerv Announcement_May 2017.docx	06/20/2017

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