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Annual Technical Assistance Survey
[NCIPC] Evaluation of the Overdose Data to Action Technical Assistance Hub
OMB: 0920-1355
IC ID: 247858
OMB.report
HHS/CDC
OMB 0920-1355
ICR 202409-0920-011
IC 247858
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Annual Technical Assistance Survey
Agency IC Tracking Number:
0920-1355
Is this a Common Form?
No
IC Status:
Modified
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
Form and Instruction
0920-1355
Annual Technical Assistance Survey
Att. 5 Annual Technical Assistance Survey.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
162
0
-278
0
0
440
Annual IC Time Burden (Hours)
27
0
-68
0
0
95
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.