Sustainability Survey Affiliate Centers

Cross-Site Evaluation of the National Child Traumatic Stress Initiative (NCTSI)

Documents and Forms

Document Name Document Type
Form Sustainability Sur Sustainability Survey Affiliate Centers Form and Instruction
Sustainability Sur Sustainability Survey Attachment I.2_Sustainability Survey_Affiliate Centers.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Sustainability Survey Affiliate Centers	Agency IC Tracking Number:

Is this a Common Form? No		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	Sustainability Survey	Sustainability Survey	Attachment I.2_Sustainability Survey_Affiliate Centers.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	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 Agency Discretion
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	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.