Information Collection

Qualitative Assessment of CDC-funded Local Health Dept Violence Prevention Efforts

IC 232124 under ICR 201711-0920-012 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Attachment B- Telephone Interview Guide.docx Other-Interview Guide
TDVYV-EVAL-SSA.DOCX Supporting Statement A IC Document
TDVYV-EVAL-SSB.DOCX Supporting Statement B IC Document
Attachment A- Respondent List.docx Respondent list IC Document
Attachment C- Notification Email.docx Notification email IC Document
Attachment D- Reminder Email.docx Reminder email IC Document
Attachment E- Confirmation Email.docx Confirmation email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Qualitative Assessment of CDC-funded Local Health Dept Violence Prevention Efforts	Agency IC Tracking Number:	0920-0879-18ARW

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-Interview Guide			Attachment B- Telephone Interview Guide.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22	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	22	22
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	TDVYV-EVAL-SSA.DOCX	07/10/2018
Supporting Statement B	TDVYV-EVAL-SSB.DOCX	07/10/2018
Respondent list	Attachment A- Respondent List.docx	07/10/2018
Notification email	Attachment C- Notification Email.docx	07/10/2018
Reminder email	Attachment D- Reminder Email.docx	07/10/2018
Confirmation email	Attachment E- Confirmation Email.docx	07/10/2018

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