[CPR] This is a T.E.S.T.

[OS] CDC/ATSDR Formative Research and Tool Development

Documents and Forms

Document Name Document Type
Form 0920-24GC [CPR] This is a T.E.S.T. Form
0920-24GC Initial Survey AttA - Immediate Post Exercise Survey.docx Form
0920-24GC Follow- up Survey AttB-FollowUp Survey.docx Form
0920-24GC Focus Group AttC-Focus Group.docx Form
Attachment 1- TEST CRC edition_Gameboard.pdf Attachment 1- TEST CRC edition_Gameboard IC Document
Attachment 1a - TEST CRC_Game Instructions.pdf Attachment 1a - TEST CRC_Game Instructions IC Document
Attachment 2 -TEST POD edition_Gameboard.pdf Attachment 2 -TEST POD edition_Gameboard IC Document
Attachment 2a -TEST_POD edition_Game Instructions.pdf Attachment 2a -TEST_POD edition_Game Instructions IC Document
Attachment 3 - TEST ICS edition_draft Gameboard.pdf Attachment 3 - TEST ICS edition_draft Gameboard IC Document
Attachment 3a - TEST ICS edition_draft Instructions.pdf Attachment 3a - TEST ICS edition_draft Instructions IC Document
Attachment D HSR Determination.pdf Attachment D HSR Determination IC Document
GenICRequestTemplate_TEST_2024.docx GenIC Request IC Document
SSB_2024_TEST.docx SSB IC Document

Information Collection (IC) Details

IC Title:	[CPR] This is a T.E.S.T.	Agency IC Tracking Number:	0920-1154-24GC

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-24GC	Initial Survey	AttA - Immediate Post Exercise Survey.docx	Yes	Yes	Fillable Fileable
Form	0920-24GC	Follow- up Survey	AttB-FollowUp Survey.docx	Yes	Yes	Fillable Fileable
Form	0920-24GC	Focus Group	AttC-Focus Group.docx	No		Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,350	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,350	2,350
Annual IC Time Burden (Hours)	875	875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 1- TEST CRC edition_Gameboard	Attachment 1- TEST CRC edition_Gameboard.pdf	06/06/2024
Attachment 1a - TEST CRC_Game Instructions	Attachment 1a - TEST CRC_Game Instructions.pdf	06/06/2024
Attachment 2 -TEST POD edition_Gameboard	Attachment 2 -TEST POD edition_Gameboard.pdf	06/06/2024
Attachment 2a -TEST_POD edition_Game Instructions	Attachment 2a -TEST_POD edition_Game Instructions.pdf	06/06/2024
Attachment 3 - TEST ICS edition_draft Gameboard	Attachment 3 - TEST ICS edition_draft Gameboard.pdf	06/06/2024
Attachment 3a - TEST ICS edition_draft Instructions	Attachment 3a - TEST ICS edition_draft Instructions.pdf	06/06/2024
Attachment D HSR Determination	Attachment D HSR Determination.pdf	06/06/2024
GenIC Request	GenICRequestTemplate_TEST_2024.docx	06/06/2024
SSB	SSB_2024_TEST.docx	06/06/2024

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