Information Collection

TA Feedback Form – Universal Events

IC 271203 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 TA Feedback Form – Universal Events	Form and Instruction
0920-1355 TA Feedback Form – Universal Events Att. 4 Universal Technical Assistance Feedback Form.docx	Form and Instruction
0920-1355 TA Feedback Form – Universal Events Att. 4 Universal Technical Assistance Feedback Form.docx	Form and Instruction
Att. 4a Screenshot_Universal Technical Assistance Feedback Form.pdf TA Feedback Form – Universal Events (screenshots)	IC Document
Att. 4a Screenshot_Universal Technical Assistance Feedback Form.pdf TA Feedback Form – Universal Events (screenshots)	IC Document

IC Title:

TA Feedback Form â Universal Events

Agency IC Tracking Number:

0920-1355

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1355	TA Feedback Form â Universal Events	Att. 4 Universal Technical Assistance Feedback Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 617

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,234	1,234
Annual IC Time Burden (Hours)	103	103
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
TA Feedback Form â Universal Events (screenshots)	Att. 4a Screenshot_Universal Technical Assistance Feedback Form.pdf	09/26/2024

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