Information Collection

Follow up Survey Assessment of CME Participants

IC 201141 under ICR 201202-0935-004 · OMB 0935-0194.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #5 Follow up Survey Assessment of CME Participants	Form
Form #5 Follow-up survey assessment for CME participants Attachment E -- Follow-up survey assessment for CME participants.docx	Form
Attachment F -- Email invitation for follow-up survey assessment.doc Attachment F -- Email invitation for follow-up survey assessment	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form #5	Follow-up survey assessment for CME participants	Attachment E -- Follow-up survey assessment for CME participants.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F -- Email invitation for follow-up survey assessment	Attachment F -- Email invitation for follow-up survey assessment.doc	02/08/2012

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