CDC Work@Health Trainee Reaction Survey Blended Model

CDC Work@Health Program: Phase 2 Training and Technical Assistance Evaluation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1006 can be found here:

Documents and Forms

Document Name Document Type
Att F-6_Work@Health Trainee Reaction Survey Blended Model.doc Other-WORD

Information Collection (IC) Details

IC Title:	CDC Work@Health Trainee Reaction Survey Blended Model	Agency IC Tracking Number:

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
Other-WORD			Att F-6_Work@Health Trainee Reaction Survey Blended Model.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: 0920-0136 Epidemiologic Studies and Survelliance of DIsease Problems	FR Citation: 57 FR 62812

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	150	-30	180
Annual IC Time Burden (Hours)	38	-7	45
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.