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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.