Community of Practice Member Satisfaction and Needs Assessment

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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
Community of Practice Member Satisfaction and Needs Assessment Form
Community of Practice Assessment - word Attachment B-Community of Practice Data Collection Word Version 09-29-20.docx Form
Community of Practice Assessment - web Attachment C-Community of Practice Data Collection Web Version 09-29-20.pdf Form
Attachment A-Community of Practice Respondent List 09-27-2020.docx Respondent list IC Document
Attachment D-community of practice notification email 9-27-2020.docx Notification email IC Document
Attachment E-Community of Practice First Reminder email 9-27-2020.docx First reminder email IC Document
Attachment F-Community of practice Final Reminder email 9-27-2020.docx Final reminder email IC Document
Community of Practice Assessment SSA 9-27-2020.docx Supporting Statement A IC Document
Community of Practice Assessment SSB 09-27-2020.docx Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	Community of Practice Member Satisfaction and Needs Assessment	Agency IC Tracking Number:	0920-0879-20SM

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
Form	none	Community of Practice Assessment - word	Attachment B-Community of Practice Data Collection Word Version 09-29-20.docx		Yes	Yes	Fillable Fileable
Form	none	Community of Practice Assessment - web	Attachment C-Community of Practice Data Collection Web Version 09-29-20.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 295	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	295	295
Annual IC Time Burden (Hours)	74	74
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Respondent list	Attachment A-Community of Practice Respondent List 09-27-2020.docx	10/06/2020
Notification email	Attachment D-community of practice notification email 9-27-2020.docx	10/06/2020
First reminder email	Attachment E-Community of Practice First Reminder email 9-27-2020.docx	10/06/2020
Final reminder email	Attachment F-Community of practice Final Reminder email 9-27-2020.docx	10/06/2020
Supporting Statement A	Community of Practice Assessment SSA 9-27-2020.docx	10/06/2020
Supporting Statement B	Community of Practice Assessment SSB 09-27-2020.docx	10/06/2020

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