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

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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Division of Violence Prevention web-based Technical assistance Participant's Feedback	Agency IC Tracking Number:	0920-17AQJ

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	0920-17AQJ	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 %

	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

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.