Feedback interviews to improve technical assistance

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.