Information Collection

Technical Assistance (TA) Satisfaction Instrument

IC 217676 under ICR 201902-0920-009 · OMB 0920-1099.

Documents and Forms

Document Name Document Type
Technical Assistance (TA) Satisfaction Instrument Form
TA Satisfaction Follow-up Att 7_TA Satisfaction Follow-up Instrument.docx Form
TA Follow-up -screenshots Att 8_TA Satisfaction_screenshot.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Technical Assistance (TA) Satisfaction Instrument	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	TA Satisfaction Follow-up	Att 7_TA Satisfaction Follow-up Instrument.docx		Yes	Yes	Fillable Fileable
Form	none	TA Follow-up -screenshots	Att 8_TA Satisfaction_screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,700	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,400	7,400
Annual IC Time Burden (Hours)	1,850	1,850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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