Information Collection

Veto Violence Evaluation Y2

IC 239278 under ICR 201902-0920-022 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 1_Participant Letter.docx	Other-WORD
Att1a_ Welcome Email.docx	Other-WORD
0920-1050 Violence Prevention in Practice Att 2a_ Violence Prevention in Practice Survey.pdf	Form
0920-1050 Connection Selector Survey Att2_Connections Selector Survey.pdf	Form and Instruction
Att 3 _Connection Selector Survey screenshot.png Att 3 Connection Selector Survey Screenshot	IC Document
Att 3a_Violence Prevention in Practice Screenshot.png Att 3a_Violence Preventin in Practice (Screenshot)	IC Document
Att 4_ PII email.pdf Att 4_PII email	IC Document
0920-1050_OMB request_VV YR2_VPP and Connections Selector.docx 0920-1050_Request for Approval	IC Document

IC Title:

Veto Violence Evaluation Y2

Agency IC Tracking Number:

0920-1050-20EI

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att 1_Participant Letter.docx	Yes	No	Printable Only
Form	0920-1050	Violence Prevention in Practice	Att 2a_ Violence Prevention in Practice Survey.pdf	Yes	Yes	Fillable Fileable
Other-WORD			Att1a_ Welcome Email.docx	Yes	No	Printable Only
Form and Instruction	0920-1050	Connection Selector Survey	Att2_Connections Selector Survey.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 580

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	580	580
Annual IC Time Burden (Hours)	628	628
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3 Connection Selector Survey Screenshot	Att 3 _Connection Selector Survey screenshot.png	01/15/2020
Att 3a_Violence Preventin in Practice (Screenshot)	Att 3a_Violence Prevention in Practice Screenshot.png	01/15/2020
Att 4_PII email	Att 4_ PII email.pdf	01/15/2020
0920-1050_Request for Approval	0920-1050_OMB request_VV YR2_VPP and Connections Selector.docx	01/15/2020

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