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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.