View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Qualitative Assessment of CDC-funded Local Health Dept Violence Prevention Efforts	Agency IC Tracking Number:	0920-0879-18ARW

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
Other-Interview Guide			Attachment B- Telephone Interview Guide.docx		Yes	No	Paper Only

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: 22	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	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	22	0	22	0	0	0
Annual IC Time Burden (Hours)	20	0	20	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	TDVYV-EVAL-SSA.DOCX	07/10/2018
Supporting Statement B	TDVYV-EVAL-SSB.DOCX	07/10/2018
Respondent list	Attachment A- Respondent List.docx	07/10/2018
Notification email	Attachment C- Notification Email.docx	07/10/2018
Reminder email	Attachment D- Reminder Email.docx	07/10/2018
Confirmation email	Attachment E- Confirmation Email.docx	07/10/2018

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