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Participating Employer - Pilot Training: Train-the-Trainer Evaluation Survey
CDC Work@Health Program: Phase 1
OMB: 0920-0989
IC ID: 208010
OMB.report
HHS/CDC
OMB 0920-0989
ICR 201308-0920-001
IC 208010
( )
Documents and Forms
Document Name
Document Type
Participating Employer - Pilot Training: Train-the-Trainer Evaluation Survey
Form
Train-the-Trainer Evaluation Survey
Attachment H_Train-the-Trainer Eval Instrument_6-25-13.doc
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Participating Employer - Pilot Training: Train-the-Trainer Evaluation Survey
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
none
Train-the-Trainer Evaluation Survey
Attachment H_Train-the-Trainer Eval Instrument_6-25-13.doc
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15
Number of Respondents for Small Entity:
15
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
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
15
0
15
0
0
0
Annual IC Time Burden (Hours)
4
0
4
0
0
0
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.