Information Collection

Recipient Meeting Participant's Feedback - Division of Violence Prevention

IC 237691 under ICR 201612-0920-007 · OMB 0920-1009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1009 Recipient Meeting Participant's Feedback - Division of Violence Prevention	Form and Instruction
0920-1009 Feedback Survey Att 1a_Post Recipient Meeting Feedback Survey 9.5.19.pdf	Form and Instruction
Att 1b_1605 Recipient Meeting Survey.png Survey Screenshot	IC Document
Att 2a_ Initial Email_9.3 Edits.docx Initial Email	IC Document
Att 2b_ Reminder Email 9.3 Edits.docx Reminder Email	IC Document
Att 3_PIA Email.pdf Privacy Assessment	IC Document
OMB# 1009 - Generic Clearance Request - Recipient Meeting 9.5.19 final.docx Generic Request Template	IC Document

IC Title:

Agency IC Tracking Number:

0920-1009-19BQQ

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	0920-1009	Feedback Survey	Att 1a_Post Recipient Meeting Feedback Survey 9.5.19.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 42

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey Screenshot	Att 1b_1605 Recipient Meeting Survey.png	09/09/2019
Initial Email	Att 2a_ Initial Email_9.3 Edits.docx	09/09/2019
Reminder Email	Att 2b_ Reminder Email 9.3 Edits.docx	09/09/2019
Privacy Assessment	Att 3_PIA Email.pdf	09/09/2019
Generic Request Template	OMB# 1009 - Generic Clearance Request - Recipient Meeting 9.5.19 final.docx	09/09/2019

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