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Post-Participation Survey
National Learning Community for HIV CBO Leadership Evaluation
OMB: 0920-1370
IC ID: 250070
OMB.report
HHS/CDC
OMB 0920-1370
ICR 202110-0920-015
IC 250070
( )
Documents and Forms
Document Name
Document Type
Form 0920-
Post-Participation Survey
Form
0920- National Learning Community for HIV CBO Leadership Post-
Att 8_Post-Participation Survey.docx
Form
Att 9_Screenshots of Post-Participation Survey.docx
Screenshots of Post-Participation Survey
IC Document
Att 7_Email invitation for Post-Participation Survey.docx
Email invitation _Post-Participation Survey
IC Document
Att 10_Email reminder for Post-Participation Survey.docx
Email reminder_Post-Participation Survey (Completion)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Post-Participation Survey
Agency IC Tracking Number:
0920-21EL
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
0920-
National Learning Community for HIV CBO Leadership Post-Participation Survey
Att 8_Post-Participation Survey.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
09-20-0161 Records of Health Professionals in Disease Prevention and Control Training Programs
FR Citation:
83 FR 6591
Number of Respondents:
270
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
270
0
270
0
0
0
Annual IC Time Burden (Hours)
41
0
41
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Screenshots of Post-Participation Survey
Att 9_Screenshots of Post-Participation Survey.docx
11/03/2021
Email invitation _Post-Participation Survey
Att 7_Email invitation for Post-Participation Survey.docx
11/03/2021
Email reminder_Post-Participation Survey (Completion)
Att 10_Email reminder for Post-Participation Survey.docx
11/03/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.