Information Collection

Prevention Workforce Evaluation

IC 268302 under ICR 202511-0704-005 · OMB 0704-0644.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
0704-0644_Integrated Primary Prevention Activity Tracker Instrument.docx Other-Tracker
0704-0644_Integrated Primary Prevention Activity Tracker Instrument.docx Other-Tracker
0704-0644_IPP Personnel Survey Insrument.docx Other-Survey
0704-0644_IPP Personnel Survey Insrument.docx Other-Survey
0704-0644_Leader and Supervisor Interview Protocols Instrument.docx Other-Protocol
0704-0644_Leader and Supervisor Interview Protocols Instrument.docx Other-Protocol
0704-0644_Case Study Protocols Instument.docx Other-Study
0704-0644_Case Study Protocols Instument.docx Other-Study
0704-0644_SSA_PWE_6.24.2024.docx
Supporting Statement Part A
IC Document
0704-0644_SSA_PWE_6.24.2024.docx
Supporting Statement Part A
IC Document
0704-0644_SSB_PWE_5.30.2024.docx
Supporting Statement Part B
IC Document
0704-0644_SSB_PWE_5.30.2024.docx
Supporting Statement Part B
IC Document
Cohort Study Email Invitation_6.10.2024.docx
Cohort Study Email Invitation
IC Document
Cohort Study Email Invitation_6.10.2024.docx
Cohort Study Email Invitation
IC Document
Leader and Supervisor Interview Invitation and Reminder_6.10.2024.docx
Leader and Supervisor Interview Invitation and Reminder
IC Document
Leader and Supervisor Interview Invitation and Reminder_6.10.2024.docx
Leader and Supervisor Interview Invitation and Reminder
IC Document
IPAcT Email invitation and Reminder_6.10.2024.docx
IPAcT Email invitation and Reminder
IC Document
IPAcT Email invitation and Reminder_6.10.2024.docx
IPAcT Email invitation and Reminder
IC Document
0704-0644_Data safety plan_Invitations_consents_protocols.pdf
Data Safety Plan_Invitations_Consents_Protocols
IC Document
0704-0644_Data safety plan_Invitations_consents_protocols.pdf
Data Safety Plan_Invitations_Consents_Protocols
IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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
Other-Tracker Yes Yes Fillable Fileable
Other-Survey Yes Yes Fillable Fileable
Other-Protocol No   Paper Only
Other-Study No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested 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 12,324 0 0 0 0 12,324
Annual IC Time Burden (Hours) 12,324 0 0 0 0 12,324
Annual IC Cost Burden (Dollars) 415,762 0 0 0 0 415,762

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Supporting Statement Part A 07/01/2024
Supporting Statement Part B 06/05/2024
Cohort Study Email Invitation 06/10/2024
Leader and Supervisor Interview Invitation and Reminder 06/10/2024
IPAcT Email invitation and Reminder 06/10/2024
Data Safety Plan_Invitations_Consents_Protocols 06/10/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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