Rigorous Evaluation Technical Assistance (RETA) Feedback Form

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Document Name Document Type
RETA - Feedback Form - Clean - 12-20-17.docx Other-Word template
Fast Track Generic - RETA Feedback Form - 12-20-17.doc RETA Fast Track Generic Submission Template IC Document

Information Collection (IC) Details

IC Title:	Rigorous Evaluation Technical Assistance (RETA) Feedback Form	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-Word template			RETA - Feedback Form - Clean - 12-20-17.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 126	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	126	126
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
RETA Fast Track Generic Submission Template	Fast Track Generic - RETA Feedback Form - 12-20-17.doc	12/20/2017

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