Application for Training - CDC Training and Continuing Education New Participant Regstration Form (36.5)

Application for Training

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0017 can be found here:

Documents and Forms

Document Name Document Type
Form CDC 36.5 Application for Training - CDC Training and Continuing Education New Participant Regstration Form (36.5) Form
CDC 36.5 Att. 3_New Participant Registration Form Attachment 3_NewParticipantRegistrationForm.pdf Form

Information Collection (IC) Details

IC Title:	Application for Training - CDC Training and Continuing Education New Participant Regstration Form (36.5)	Agency IC Tracking Number:

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	CDC 36.5	Att. 3_New Participant Registration Form	Attachment 3_NewParticipantRegistrationForm.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-01610-Records of Health Professionals in Disease Prevention and Control Training Programs	FR Citation: 51 FR 42485

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	1,667	1,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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