Aim 1 Provider Pre- Training Survey

[NCHHSTP] _Expanding PrEP in Communities of Color (EPICC) (24BY)

Documents and Forms

Document Name Document Type
Form MOD00003217 Aim 1 Provider Pre- Training Survey Form and Instruction
MOD00003217 Aim 1 Provider Pre-Training Survey Att 4c_Aim1ProviderPreTrainingSurvey CLEAN.docx Form and Instruction
MOD00003217 Aim 1 Provider Pre-Training Survey Att 4c_Aim1ProviderPreTrainingSurvey CLEAN.docx Form and Instruction
Att 4c.1_Aim1ProviderPreTrainingSurvey (TC).docx Att 4c.1_ Aim 1 Provider Pre-Training Survey.(TC) IC Document
Att 4c.1_Aim1ProviderPreTrainingSurvey (TC).docx Att 4c.1_ Aim 1 Provider Pre-Training Survey.(TC) IC Document

Information Collection (IC) Details

IC Title:	Aim 1 Provider Pre- Training Survey	Agency IC Tracking Number:	0920-1423-24BY

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	MOD00003217	Aim 1 Provider Pre-Training Survey	Att 4c_Aim1ProviderPreTrainingSurvey CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4c.1_ Aim 1 Provider Pre-Training Survey.(TC)	Att 4c.1_Aim1ProviderPreTrainingSurvey (TC).docx	01/05/2024

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