Client Pre Survey (English, Spanish, and Chinese)

Survey to Evaluate Occupational and Safety Educational Materials for Home Care Workers

OMB: 0920-0880

IC ID: 195733

Information Collection (IC) Details

View Information Collection (IC)

Client Pre Survey (English, Spanish, and Chinese)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att C3- Client pre survey OMBcomments.docx Yes Yes Fillable Printable

Health Illness Prevention

 

320 0
   
Individuals or Households
 
   100 %

  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 320 320 0 0 0 0
Annual IC Time Burden (Hours) 80 80 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att I_Consent documents Att I_Consent documents.doc 11/01/2010
Att I- Consent Documents (3) Att I- Consent Documents (3).docx 03/08/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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