Violence Prevention Technical Assistance Center: Needs Assess

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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

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.