CDC Work@Health Train-the-Trainer Participant Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 G-3_Work@HealthTrain-the-Trainer Participant Survey.docx Other-WORD
Att G-4_ ScrShots of Train-the-Trainer Participant Survey.docx Att G-4_ ScrShots of Train-the-Trainer Participant Survey IC Document

Information Collection (IC) Details

IC Title:	CDC Work@Health Train-the-Trainer Participant Survey	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 G-3_Work@HealthTrain-the-Trainer Participant Survey.docx		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: 120	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	Previously Approved
Annual Number of Responses for this IC	120	60	60
Annual IC Time Burden (Hours)	40	20	20
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att G-4_ ScrShots of Train-the-Trainer Participant Survey	Att G-4_ ScrShots of Train-the-Trainer Participant Survey.docx	12/02/2013

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