Formative Evaluation of Professional Development Resources - Web Survey

Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0840 Formative Evaluation of Professional Development Resources - Web Survey Form and Instruction
Att 3_Survey.docx Other-WORD
0920-0840 Formative Evaluation of Professional Development Resourc Att 3a_Screen Shots of Survey.pdf Form and Instruction
SS A.doc Supporting Statement A IC Document
SS B.docx Supporting Statement B IC Document
Att 1_Auth Legislation.doc Att 1_ Authorizing Leg IC Document
Att 2_60 Day FRN.pdf Att 2_60dy FRN IC Document
Att 4_Consultants.docx Att 4_Consultant IC Document
Att 5_Informed Consent.docx Att 5_ Informed Consent IC Document
Att 6_Email Invite_Reminder Email.docx Att 6_Email Invite_Reminder IC Document
Att 7_ICF IRB Exempt Approval Documents 2-11-19.pdf Att 7_ICF IRB IC Document
Att 8_Respondent Universe.docx Att 8_Respondent Universe IC Document

Information Collection (IC) Details

IC Title:	Formative Evaluation of Professional Development Resources - Web Survey	Agency IC Tracking Number:	0920-0840-19ANZ

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	0920-0840	Formative Evaluation of Professional Development Resources - Web Survey	Att 3a_Screen Shots of Survey.pdf		Yes	Yes	Fillable Fileable
Other-WORD			Att 3_Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 475	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	475	475
Annual IC Time Burden (Hours)	174	174
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	SS A.doc	04/24/2019
Supporting Statement B	SS B.docx	04/24/2019
Att 1_ Authorizing Leg	Att 1_Auth Legislation.doc	04/24/2019
Att 2_60dy FRN	Att 2_60 Day FRN.pdf	04/24/2019
Att 4_Consultant	Att 4_Consultants.docx	04/24/2019
Att 5_ Informed Consent	Att 5_Informed Consent.docx	04/24/2019
Att 6_Email Invite_Reminder	Att 6_Email Invite_Reminder Email.docx	04/24/2019
Att 7_ICF IRB	Att 7_ICF IRB Exempt Approval Documents 2-11-19.pdf	04/24/2019
Att 8_Respondent Universe	Att 8_Respondent Universe.docx	04/24/2019

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