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

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-25-0172

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	n/a				Yes	Yes	Fillable Fileable
Form and Instruction	n/a				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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Template		09/18/2025
Survey Monkey Group Learning Events		09/18/2025
Survey Monkey Peer Learning Community		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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