Bullying Prevention Training Modules Feedback Forms

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form A Bullying Prevention Training Modules Feedback Forms Form and Instruction
A Form A For Participants in the Bullying Prevention Modul Form A For Participants in the Bullying Prevention Modules Training 7 17.docx Form and Instruction
B Form B Follow-Up Form For Participants in the Bullying P Form B Follow-Up Form For Participants in the Bullying Prevention Training Module 7-17.docx Form and Instruction
C Form C For participants in Community_Events_7-17 Form C For participants in Community_Events_7-17.docx Form and Instruction
D Form D Follow-Up Form For Community Event Participant 7- Form D Follow-Up Form For Community Event Participant 7-17.docx Form and Instruction
Supporting Statement.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Bullying Prevention Training Modules Feedback Forms	Agency IC Tracking Number:

IC Status: New

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 and Instruction	A	Form A For Participants in the Bullying Prevention Modules Training 7 17	Form A For Participants in the Bullying Prevention Modules Training 7 17.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B	Form B Follow-Up Form For Participants in the Bullying Prevention Training Module 7-17	Form B Follow-Up Form For Participants in the Bullying Prevention Training Module 7-17.docx	Yes	Yes	Fillable Fileable
Form and Instruction	C	Form C For participants in Community_Events_7-17	Form C For participants in Community_Events_7-17.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D	Form D Follow-Up Form For Community Event Participant 7-17	Form D Follow-Up Form For Community Event Participant 7-17.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	700	0	0	0	0	0
Annual IC Time Burden (Hours)	175	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Supporting Statement.docx	07/18/2012

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