Information Collection

Annual Technical Assistance Survey

IC 247858 under ICR 202409-0920-011 · OMB 0920-1355.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1355 Annual Technical Assistance Survey	Form and Instruction
0920-1355 Annual Technical Assistance Survey Att. 5 Annual Technical Assistance Survey.docx	Form and Instruction
0920-1355 Annual Technical Assistance Survey Att. 5 Annual Technical Assistance Survey.docx	Form and Instruction
Att. 5a Screenshot_Annual Technical Assistance Survey.pdf Annual Technical Assistance Survey (screenshot)	IC Document
Att. 5a Screenshot_Annual Technical Assistance Survey.pdf Annual Technical Assistance Survey (screenshot)	IC Document
Att. 7 Email Invitation Annual Technical Assistance Survey.docx Email Invitation (DOP TAC Annual Survey)	IC Document
Att. 7 Email Invitation Annual Technical Assistance Survey.docx Email Invitation (DOP TAC Annual Survey)	IC Document

IC Title:

Agency IC Tracking Number:

0920-1355

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	0920-1355	Annual Technical Assistance Survey	Att. 5 Annual Technical Assistance Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 162

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	162	-278	440
Annual IC Time Burden (Hours)	27	-68	95
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Annual Technical Assistance Survey (screenshot)	Att. 5a Screenshot_Annual Technical Assistance Survey.pdf	09/26/2024
Email Invitation (DOP TAC Annual Survey)	Att. 7 Email Invitation Annual Technical Assistance Survey.docx	09/26/2024

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