Customer Feedback on CAMP Teen-SPARC Tool Use and Usability

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⚠️ Notice: This information collection may be referencing outdated material.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 Customer Feedback on CAMP Teen-SPARC Tool Use and Usability Form and Instruction
0920-1050 SPARC Survey Att1 teen-SPARC SurveyQuestions.docx Form and Instruction
Customer Service GenIC Clearance Template_DASH_teen-SPARC.docx Customer Service Template IC Document

Information Collection (IC) Details

IC Title:	Customer Feedback on CAMP Teen-SPARC Tool Use and Usability	Agency IC Tracking Number:	0920-1050-20PN

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	0920-1050	SPARC Survey	Att1 teen-SPARC SurveyQuestions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Customer Service Template	Customer Service GenIC Clearance Template_DASH_teen-SPARC.docx	06/23/2020

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