Customer Satisfaction and Usability of the Technical Packages for Violence Prevention

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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Customer Satisfaction and Usability of the Technical Packages for Violence Prevention	Agency IC Tracking Number:	17AYY

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
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 %

	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

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.