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Training participant questionnaire
Assessing the Impact of the National Implementation of TeamSTEPPS Master Training Program
OMB: 0935-0170
IC ID: 193967
OMB.report
HHS/AHRQ
OMB 0935-0170
ICR 201507-0935-002
IC 193967
( )
Documents and Forms
Document Name
Document Type
Form 1
Training participant questionnaire
Form and Instruction
1 Training participant questionnaire
ATTACHMENT C --Training Participant Questionnaire rev091415.docx
Form and Instruction
ATTACHMENT D -- Emails_2015-09-10 rev091415.docx
Advance notice, invitation, reminder notices, and thank you letters for training participant questionnaire
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Training participant questionnaire
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
Form and Instruction
1
Training participant questionnaire
ATTACHMENT C --Training Participant Questionnaire rev091415.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
240
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:
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
2,400
0
0
0
0
2,400
Annual IC Time Burden (Hours)
800
0
0
0
0
800
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Advance notice, invitation, reminder notices, and thank you letters for training participant questionnaire
ATTACHMENT D -- Emails_2015-09-10 rev091415.docx
09/17/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.