[NCIPC] Violence Prevention Technical Assistance Center Participant Feedback Forms

[OADC] CDC Usability and Digital Content Testing

Documents and Forms

Document Name Document Type
Form 0920-1050 [NCIPC] Violence Prevention Technical Assistance Center Participant Feedback Forms Form and Instruction
0920-1050 Participant Feedback Form for Group Learning Events Att. 2 Participant Feedback Form for Group Learning Events.docx Form and Instruction
0920-1050 Participant Feedback Form for Peer Learning Communities Att. 3 Participant Feedback Form for Peer Learning Communities.docx Form and Instruction
0920-1050 Recipient Feedback Form for Individual TA Att. 4 Recipient Feedback Form for Individual TA.docx Form and Instruction
0920-1050 Recipient Follow Up Form for Individual TA Att. 5 Recipient Follow Up Form for Individual TA.docx Form and Instruction
Request_OMB1050_GenIC_Violence Prevention_TA center feedback _7.14.23.docx GenIC Request Template - 0920-1050 IC Document
Att. 1 VPTAC Privacy Act-Determination.pdf Privacy Act Determination - signed IC Document

Information Collection (IC) Details

IC Title:	[NCIPC] Violence Prevention Technical Assistance Center Participant Feedback Forms	Agency IC Tracking Number:	0920-1050-23GX

IC Status: Unchanged

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	0920-1050	Participant Feedback Form for Group Learning Events	Att. 2 Participant Feedback Form for Group Learning Events.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Participant Feedback Form for Peer Learning Communities	Att. 3 Participant Feedback Form for Peer Learning Communities.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Recipient Feedback Form for Individual TA	Att. 4 Recipient Feedback Form for Individual TA.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Recipient Follow Up Form for Individual TA	Att. 5 Recipient Follow Up Form for Individual TA.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 725	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	725	725
Annual IC Time Burden (Hours)	131	131
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Template - 0920-1050	Request_OMB1050_GenIC_Violence Prevention_TA center feedback _7.14.23.docx	08/07/2023
Privacy Act Determination - signed	Att. 1 VPTAC Privacy Act-Determination.pdf	08/07/2023

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