Veto Violence Evaluation Y2

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.