Information Collection

[2022] VetoViolence Training and Resource Development - Health Equity

IC 253053 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⚠️ Notice: This information collection may be referencing outdated material.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
Interview Recruitment Materials [2022] VetoViolence Training and Resource Development - Health Equity	Form and Instruction
Interview Consent and Interview Guide [2022] VetoViolence Training and Resource Development - Health Equity	Form and Instruction
Survey Recruitment Materials [2022] VetoViolence Training and Resource Development - Health Equity	Form and Instruction
Survey Consent and Questionnaire [2022] VetoViolence Training and Resource Development - Health Equity	Form and Instruction
Interview Recruitment Materials Att 2 HE Interview_Recruitment Materials_04252022.docx	Form and Instruction
Interview Consent and Interview Guide Att 3 HE Interview_Consent Form and Interview Guide_04252022.docx	Form and Instruction
Survey Recruitment Materials Att 4 HE Survey_Recruitment Materials_04252022.docx	Form and Instruction
Survey Consent and Questionnaire Att 5 HE Survey_ Consent Form and Survey_04252022.docx	Form and Instruction
Veto HE OMB Generic Package_04252022.docx GENIC Template with Project Description (VetoViolence training)	IC Document
Att 1_Veto Violence HE PIA.pdf CDC Determination: The Privacy Act does not apply	IC Document

IC Title:

[2022] VetoViolence Training and Resource Development - Health Equity

Agency IC Tracking Number:

0920-22EQ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Yes	Yes	Fillable Printable
Form and Instruction	None	Yes	Yes	Fillable Printable
Form and Instruction	None	Yes	Yes	Fillable Printable
Form and Instruction	None	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,110

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,110	1,110
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GENIC Template with Project Description (VetoViolence training)		04/25/2022
CDC Determination: The Privacy Act does not apply		04/25/2022

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

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