DISCC_UTA_Registration_Survey 20240625

DISCC UTA Registration Survey

6/25/2024

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Please provide the following information to register:

• * First Name __________________________________________________

• * Last Name __________________________________________________

• * Email Address __________________________________________________

• * Job Title __________________________________________________

• * Type of Organization You Represent (select one)

  • State CCDF Lead Agency

  • Territory CCDF Lead Agency

  • Tribal CCDF Lead Agency

  • CCTAN Center

  • OCC

  • Other

• * Organization __________________________________________________

• * State/Territory in which your organization is located __________________________________________________

• Do you require any specific accommodations? __________________________________________________

• What questions do you hope will be answered during this webinar? __________________________________________________

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*=required field

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to request registration information for planning UTA webinars and peer learning activities. Public reporting burden for this collection of information is estimated to average 1 minute per respondent, including the time for reviewing instructions, gathering and maintaining the data needed and reviewing the collection of information. This is a voluntary collection of information, agency may not conduct or sponsor, and a person is not required to respond to a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0617 and the expiration date is 9/30/2026. If you have any comments on this collection of information, please contact Donna Seymour, 202-763-4000, [email protected].