Information Collection

Feedback interviews to improve technical assistance

IC 243165 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment 1. Feedback Moderator Guide.docx	Other-WORD
1050 OMB generic request_TA_ORRT.docx Request for Approval	IC Document
Attachment 2. Privacy appllicability.pdf Att 2_Privacy Applicability	IC Document

IC Title:

Feedback interviews to improve technical assistance

Agency IC Tracking Number:

0920-1050-20RG

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			Attachment 1. Feedback Moderator Guide.docx		No		Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	500	500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	1050 OMB generic request_TA_ORRT.docx	08/13/2020
Att 2_Privacy Applicability	Attachment 2. Privacy appllicability.pdf	08/13/2020

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