Information Collection

Violence Prevention Technical Assistance Center: Needs Assess

IC 242515 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⚠️ Notice: This information collection may be referencing outdated material.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 2. Needs Assessment Survey.docx	Other-WORD
Att 3. Participant Satisfaction Survey .docx	Other-WORD
Request GenIc1050 VPTAC Needs Assessment and Feedback.docx Request for Approval	IC Document
Att 1. Privacy Applicability.pdf Att 1_Privacy Applicability	IC Document

IC Title:

Violence Prevention Technical Assistance Center: Needs Assess

Agency IC Tracking Number:

0920-1050-20QC

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att 2. Needs Assessment Survey.docx		No		Fillable Fileable
Other-WORD			Att 3. Participant Satisfaction Survey .docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 524

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	524	524
Annual IC Time Burden (Hours)	112	112
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Request GenIc1050 VPTAC Needs Assessment and Feedback.docx	07/13/2020
Att 1_Privacy Applicability	Att 1. Privacy Applicability.pdf	07/13/2020

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