Information Collection

Student Program Master Trainer Technical Assistance Tracking Form

IC 201415 under ICR 201207-0920-010 · OMB 0920-0941.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0941 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DDDD STUDENT PROGRAM MASTER TRAINER TECHNICAL ASSISTANCE TRACKING FORM	Form
DDDD STUDENT PROGRAM MASTER TRAINER TECHNICAL ASSISTANCE TRAC Atmt DDDD Student Master Trainer TA Track Form.docx	Form

IC Title:

STUDENT PROGRAM MASTER TRAINER TECHNICAL ASSISTANCE TRACKING FORM

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	DDDD	STUDENT PROGRAM MASTER TRAINER TECHNICAL ASSISTANCE TRACKING FORM	Atmt DDDD Student Master Trainer TA Track Form.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.