Evaluation Form - Administrators

Workplace Violence Prevention Programs In New Jersey Healthcare Facilities

OMB: 0920-0914

IC ID: 199793

Information Collection (IC) Details

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Evaluation Form - Administrators
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Evaluation Form 10 7 2011attachment-C1.docx Yes No Fillable Fileable

Health Public Health Monitoring

 

50 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 50 0 0 0 0 50
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Letter of Introduction and Fact Sheet Appendix D updated 9.30.11.docx 10/13/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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