Evaluation of Facilitation Services (Participant) - IC for State, Local and Tribal Govt. Respondents

Program Evaluation Instruments - Collaborative Problem Solving Facilitation Services (Two Instruments)

Documents and Forms

Document Name Document Type
Form 3320-000N(1) Evaluation of Facilitation Services (Participant) - IC for State, Local and Tribal Govt. Respondents Form and Instruction
3320-000N(1) Facilitation Services - Participant Questionnaire (Rev 2 Facilitation Services Participant Questionnaire (Rev2011).pdf Form and Instruction
3320-000N(1) Facilitation Services - Participant Questionnaire Rev 20 Facilitation Services Participant Questionnaire _Rev2012_.pdf Note; Currently being completed Form and Instruction

Information Collection (IC) Details

IC Title:	Evaluation of Facilitation Services (Participant) - IC for State, Local and Tribal Govt. Respondents	Agency IC Tracking Number:	000Nb

Is this a Common Form? No		IC Status: Modified

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	3320-000N(1)	Facilitation Services - Participant Questionnaire (Rev 2011)	Facilitation Services Participant Questionnaire (Rev2011).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	3320-000N(1)	Facilitation Services - Participant Questionnaire Rev 2012	Facilitation Services Participant Questionnaire _Rev2012_.pdf	Note; Currently being completed	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 530	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	530	-70	600
Annual IC Time Burden (Hours)	106	-94	200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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