Information Collection

Regorous Evaluation Technical Assistance (RETA) Feedback Form

IC 230091 under ICR 201801-0970-013 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Regorous Evaluation Technical Assistance (RETA) Feedback Form	Form and Instruction
1 RETA-Feedback Form RETA - Feedback Form - Clean - 12-20-17.docx	Form and Instruction
RETA - Fast Track Generic - Submission Form - 12-20-17.doc Justification	IC Document

IC Title:

Regorous Evaluation Technical Assistance (RETA) Feedback Form

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
Form and Instruction	1	RETA-Feedback Form	RETA - Feedback Form - Clean - 12-20-17.docx		Yes	Yes	Fillable Printable

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: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	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

table that charts IC Documents
Title	Document	Date Uploaded
Justification	RETA - Fast Track Generic - Submission Form - 12-20-17.doc	02/13/2018

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