Information Collection

Community of Practice Member Satisfaction and Needs Assessment

IC 243890 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.