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State and Community Awardee Training and Technical Assistance Reporting Form
Process Evaluation of "Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through Community-Wide Initiatives"
OMB: 0920-0952
IC ID: 203976
OMB.report
HHS/CDC
OMB 0920-0952
ICR 201409-0920-009
IC 203976
( )
Documents and Forms
Document Name
Document Type
Form no
State and Community Awardee Training and Technical Assistance Reporting Form
Form
no State and Community Awardee Training and Technical Assis
Attachment 9. State and Community Awardee Training and Technical Assistance Tool.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
State and Community Awardee Training and Technical Assistance Reporting Form
Agency IC Tracking Number:
Is this a Common Form?
No
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
no
State and Community Awardee Training and Technical Assistance Reporting Form
Attachment 9. State and Community Awardee Training and Technical Assistance Tool.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:
50
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
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
600
0
0
0
0
600
Annual IC Time Burden (Hours)
600
0
0
0
0
600
Annual IC Cost Burden (Dollars)
0
0
0
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.