Information Collection

Models of Coordination and Technical Assistance to Achieve Outcomes in Communities

IC 239306 under ICR 201705-0990-002 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Document Name Document Type
0990-0421Attachment A - Key informant semi-structured discussion guide on using policy levers_OMB - ASPE edits 3.11.20.docx Other-guidance
0990-0421Attachment B - Focus group discussion guide on experiences receiving TA.docx Other-DISCUSSION
SupportingStatement A_Models of Coordination - updated 3.11.20.docx SS-A IC Document
0990-0421 SupportingStatement B_Models of Coordination - 1.15.20_OMB - ASPE edits 3.11.20.docx SS-B IC Document
0990-0421ASPE Generic_Cover sheet_Models of Coordination - 1.15.20.docx COVERSHEET IC Document
Attachment C - Template Recruitment Email for Key Informants on Using Policy Levers.docx Att C - Template recruitment email IC Document
Attachment D - Template Recruitment Email for Focus Groups on Experiences Receiving TA.docx Att D - Template Recruitment Email IC Document
Attachment F - Template Follow-Up Email for Focus Groups on Experiences Receiving TA.docx Att F - Template Follow-Up Email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Models of Coordination and Technical Assistance to Achieve Outcomes in Communities	Agency IC Tracking Number:

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-guidance			0990-0421Attachment A - Key informant semi-structured discussion guide on using policy levers_OMB - ASPE edits 3.11.20.docx		No		Paper Only
Other-DISCUSSION			0990-0421Attachment B - Focus group discussion guide on experiences receiving TA.docx		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 47	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	47	47
Annual IC Time Burden (Hours)	62	62
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SS-A	SupportingStatement A_Models of Coordination - updated 3.11.20.docx	03/13/2020
SS-B	0990-0421 SupportingStatement B_Models of Coordination - 1.15.20_OMB - ASPE edits 3.11.20.docx	03/13/2020
COVERSHEET	0990-0421ASPE Generic_Cover sheet_Models of Coordination - 1.15.20.docx	01/16/2020
Att C - Template recruitment email	Attachment C - Template Recruitment Email for Key Informants on Using Policy Levers.docx	03/13/2020
Att D - Template Recruitment Email	Attachment D - Template Recruitment Email for Focus Groups on Experiences Receiving TA.docx	03/13/2020
Att F - Template Follow-Up Email	Attachment F - Template Follow-Up Email for Focus Groups on Experiences Receiving TA.docx	03/13/2020

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