Information Collection

[NCIPC] Violence Prevention Technical Assistance Center: TTA Participant Feedback Forms

IC 277597 under ICR 202506-0920-002 · OMB 0920-1050.

Documents and Forms

Document Name Document Type
Participant Feedback Form for Group Learning Events [NCIPC] Violence Prevention Technical Assistance Center: TTA Participant Feedback Forms Form and Instruction
Participant Feedback Form for Peer Learning Communities [NCIPC] Violence Prevention Technical Assistance Center: TTA Participant Feedback Forms Form and Instruction
Participant Feedback Form for Group Learning Events Att 2_Participant Feedback Form for Group Learning Events.docx Form and Instruction
Participant Feedback Form for Peer Learning Communities Att 3_Participant Feedback Form for Peer Learning Communities.docx Form and Instruction
2025.09.11 1050 Request Service Delivery - VPTAC_final.docx GenIC Request Template IC Document
Att 2a_SurveyMonkey_Group Learning Events.pdf Survey Monkey Group Learning Events IC Document
Att 3a_SurveyMonkey_Peer Learning Community.pdf Survey Monkey Peer Learning Community IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NCIPC] Violence Prevention Technical Assistance Center: TTA Participant Feedback Forms	Agency IC Tracking Number:	0920-25-0172

IC Status: New

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	n/a	Participant Feedback Form for Group Learning Events	Att 2_Participant Feedback Form for Group Learning Events.docx		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Participant Feedback Form for Peer Learning Communities	Att 3_Participant Feedback Form for Peer Learning Communities.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 680	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	680	680
Annual IC Time Burden (Hours)	114	114
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Template	2025.09.11 1050 Request Service Delivery - VPTAC_final.docx	09/18/2025
Survey Monkey Group Learning Events	Att 2a_SurveyMonkey_Group Learning Events.pdf	09/18/2025
Survey Monkey Peer Learning Community	Att 3a_SurveyMonkey_Peer Learning Community.pdf	09/18/2025

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

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