Information Collection

Customer Satisfaction and Usability of the Technical Packages for Violence Prevention

IC 228321 under ICR 201612-0920-007 · OMB 0920-1009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att. A Instrument.docx	Other-WORD
Att. B DVP Screenshot.docx	Other-Sreenshots
Request GenIc DVP-TP.docx Request for Approval	IC Document

IC Title:

Agency IC Tracking Number:

17AYY

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
Other-WORD			Att. A Instrument.docx		Yes	Yes	Fillable Fileable
Other-Sreenshots			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: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	2,000	2,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Request GenIc DVP-TP.docx	09/13/2017

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