View Information Collection (IC)

View Information Collection (IC)

IC Title:	Impact of Training and Technical Assistance Tool	Agency IC Tracking Number:

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	TTA Tool	TTA Tool	Attachment 1-TA Network_QA Survey.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	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	800	0	800	0	0	0
Annual IC Time Burden (Hours)	136	0	136	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
IRB	Attachment 3-IRB Determination Letter.pdf	11/04/2014
Supporting Statement	TA Network Supporting Statement CQI Final.docx	11/04/2014
Transmittal Letter	Trans.Let-3-2014.doc	11/04/2014

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