Information Collection

Introductory Session Landscape Assessment

IC 239911 under ICR 202002-0920-004 · OMB 0920-1300.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-19BOI Introductory Session Landscape Assessment	Form and Instruction
19BOI Att 1h Programmed Landscape Ass Survey Orgs Final.pdf	Other-programmed view
19BOI Att 1i. Programmed Landscape Ass Survey Class Locs Final.pdf	Other-programmed view
0920-19BOI Introductory Session Landscape Assessment 19BOI Att 1aa Intro Session Survey Class Locations Final.docx	Form and Instruction
0920-19BOI Pre Session Survey 19BOI Att 2 Pre Session Survey Final.docx	Form and Instruction
0920-19BOI Post- Session Survey 19BOI Att 3 Post-Session Survey Final.docx	Form and Instruction
0920-19BOI BYB Discovery Session Implementation Fidelity Checklist 19BOI Att 5 BYB Implem Fidelity Chklst Final.xlsx	Form and Instruction
0920-19BOI REGISTRATION AND ATTENDANCE TRACKING FORM 19BOI Att 4 Registration & Attendance Form Final.xlsm	Form and Instruction
19BOI Att 1 Organizations Final.docx Introductory Session Landscape Assessment	IC Document

IC Title:

Agency IC Tracking Number:

0920-19BOI

Is this a Common Form? No

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-19BOI	Introductory Session Landscape Assessment	19BOI Att 1aa Intro Session Survey Class Locations Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-19BOI	Pre Session Survey	19BOI Att 2 Pre Session Survey Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-19BOI	Post- Session Survey	19BOI Att 3 Post-Session Survey Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-19BOI	BYB Discovery Session Implementation Fidelity Checklist	19BOI Att 5 BYB Implem Fidelity Chklst Final.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-19BOI	REGISTRATION AND ATTENDANCE TRACKING FORM	19BOI Att 4 Registration & Attendance Form Final.xlsm	Yes	Yes	Fillable Fileable
Other-programmed view			19BOI Att 1h Programmed Landscape Ass Survey Orgs Final.pdf	Yes	Yes	Fillable Fileable
Other-programmed view			19BOI Att 1i. Programmed Landscape Ass Survey Class Locs Final.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,478

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

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	5,478	5,478
Annual IC Time Burden (Hours)	1,572	1,572
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Introductory Session Landscape Assessment	19BOI Att 1 Organizations Final.docx	02/11/2020

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