Information Collection

Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation

IC 270921 under ICR 202608-0906-005 · OMB 0906-0084.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Comprehensive Survey Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation	Form and Instruction
Form 2 Post-TA Activity Survey Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation	Form and Instruction
Form 3 Qualitative Interview Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation	Form and Instruction
1 Comprehensive Survey 2024-09-12_SATA_Comprehensive-Survey-and-Consent_Final.docx	Form and Instruction
2 Post-TA Activity Survey 2024-09-12_SATA_Post-TA-Activity-Survey-and-Consent_Final.docx	Form and Instruction
3 Qualitative Interview 2024-09-12_SATA_Qual-Interview-Guide-and-Consent_Final.docx	Form and Instruction
2024-09-12_SATA_OMB-Fast-Track-Memo.docx Generic IC Memo_SATA Evaluation	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form and Instruction	2	Yes	Yes	Fillable Fileable
Form and Instruction	3	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 582

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	582	582
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic IC Memo_SATA Evaluation		09/12/2024

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

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