Evaluators' Network, Member Survey

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1050 Evaluators' Network, Member Survey Form
GIC 1050 Survey Invite Primry Blog Post.docx Instruction
0920-1050 2020 Annual Evaluators' Network Member Survey GIC 1050 Ann Eval Ntwrk Mbr Survey.docx Form
GIC 1050 Cover Form.docx Request for Approval IC Document
GIC 1050 Remind Blog Post.docx Evaluators’ Network Member Survey Invitation, Follow-Up Reminder Blog Post IC Document
GIC 1050 Survey Invite Primry Email.docx Invitational Email IC Document

Information Collection (IC) Details

IC Title:	Evaluators' Network, Member Survey	Agency IC Tracking Number:	0920-1050-20OL

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	0920-1050	2020 Annual Evaluators' Network Member Survey	GIC 1050 Ann Eval Ntwrk Mbr Survey.docx		Yes	Yes	Fillable Fileable
Instruction			GIC 1050 Survey Invite Primry Blog Post.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 170	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	170	170
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	GIC 1050 Cover Form.docx	05/21/2020
Evaluators’ Network Member Survey Invitation, Follow-Up Reminder Blog Post	GIC 1050 Remind Blog Post.docx	05/21/2020
Invitational Email	GIC 1050 Survey Invite Primry Email.docx	05/21/2020

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