Application for Training - CDC Training and Continuing Education New Participant Registration Form 36.5

Attachment 4
Training and Continuing Education Online New Participant Registration Form, electronic form 36.5

TCEO New
Participant
Registration Form

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APPLICATION
FOR TRAINING

Table of Contents
1. Introduction ......................................................................................................................................................................... 2
2. Create Account ................................................................................................................................................................... 3
3. Profession Specifc Data ...................................................................................................................................................... 6

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1. Introduction
The purpose of this document is to specify the data elements collected online through the new participant
registration form from learners who wish to obtain continuing education from the Centers for Disease Control
and Prevention (CDC) accredited education activities.
The Training and Continuing Education Online System (TCEO) is a streamlined application for applicants
(learners) to submit their application online and receive continuing education for identified accredited activities
in which they have participated as well as track their amount of continuing education earned. TCEO is a robust
flexible framework tailored for the various healthcare professions requiring continuing education for
certification and licensure.
To comply with new data collection requirements imposed by accreditation organizations, CDC must collect
additional profession-specific data through the Training and Continuing Education Online New Participant
Registration Form. The changes to the information collection are denoted in this document with yellow
highlighting.

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2. Create Account
To create an account in the Training and Continuing Education Online System (TCEO) participants are required
to complete the data fields shown in the Create Account Screen (Figure 1). The data element options to create
an account are shown in Table 1.

Figure 1—Create Account Screen

Form Approved
OMB No. 0920-0017
Exp. Date xx/xx/20xx

reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74,
Atlanta, Georgia 30333; ATTN: PRA(0920-0017).

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Table 1—Create Account Data Elements
Display property

Column Label

Entity Figure

List of Values

First name:

Person

2

N/A

Last name:

Person

2

N/A

Middle initial:

Person

2

N/A

Address:

Person

2

N/A

Country:

Person

2

City:

Person

2

State/territory/
province:

Person

2

Zip/postal code:

Person

2

Education:

Person

2

If Education = MD/PhD, MD/JD or equivalent dual advanced degrees
(specify)

Specify:

Person

2

N/A

If Education = Other (specify)

Specify:

Person

2

N/A

Work setting:

Person

2

If Work setting = Academic / Educational Institution (specify)

Specify:

Person

2a

WorkAcademic

If Work setting = Public Health Agency (specify)

Specify:

Person

2b

WorkPH

If Work setting = Military (specify)

Specify:

Person

2c

WorkMilitary

If Work setting = Other Government Agency (specify)

Specify:

Person

2d

If Work setting = Healthcare (specify)

Specify:

Person

2e

If Work setting = Healthcare (specify) / Other (specify)

Specify:

Person

2e

N/A

If Work setting = Non-Profit Organization (specify)

Specify:

Person

2f

N/A

If Work setting = Other (specify)

Specify:

Person

2g

N/A

Employer:

Person

2

N/A

Daytime phone:

Person

2

N/A

Primary profession: Person

2

If Primary profession = Allied Health Professional (specify)

Specialty:

Person

2j

If Primary profession = Allied Health Professional (specify) / Other
Allied Health Professional (specify)

Specify:

Person

2j

If Primary profession = Dental Professional (specify)

Specify:

Person

2a

ProfessionDental

If Primary profession = Emergency Responder (specify)

Specialty:

Person

2b

ProfessionEmerg

If Primary profession = Emergency Responder (specify) / Other
Emergency Responders (specify)

Specify:

Person

2b

N/A

If Primary profession = Environmental Health Professional (specify)

Specialty:

Person

2c

ProfessionEnviron

If Primary profession = Environmental Health Professional (specify) /
Other (specify)

Specialty:

Person

2c

Person

2d

ProfessionGov
ProfessionMental

If Work setting ≠ CDC/ATSDR ≠ Military

If Primary profession = Government Official (specify)

Country
N/A
State
N/A
Education

Work

N/A
WorkHealthcare

Profession
ProfessionAllied
N/A

N/A

If Primary profession = Mental and Behavioral Health Professional
(specify)

Specialty:

Person

2e

If Primary profession = Mental and Behavioral Health Professional
(specify) / Other (specify)

Specify:

Person

2e

If Primary profession = Nursing Professional (specify)

Specialty:

Person

2f

ProfessionNurse

If Primary profession = Nursing Professional (specify) / Registered
Nurse (RN or RN,C) (specify)

Subspecialty:

Person

2f

ProfessionRN

N/A

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Display property

Column Label

Entity Figure
2f

List of Values

If Primary profession = Nursing Professional (specify) / Advance
Practice Nurse (APRN) (specify)

Subspecialty:

Person

ProfessionAPRN

If Primary profession = Other Medical Professional (specify)

Specialty:

Person

If Primary profession = Pharmacy Professional (specify)

Specialty:

Person

2g

ProfessionPharm

If Primary profession = Physician (specify)

Specialty:

Person

2h

ProfessionPhysician

If Primary profession = Physician (specify) / Internal Medicine

Subspecialty:

Person

2h

ProfessionInternal

ProfMedOther

If Primary profession = Physician (specify) / Pediatrics (specify)

Subspecialty:

Person

2h

ProfessionPediatrics

If Primary profession = Physician (specify) / Other (specify)

Specify:

Person

2i

N/A

If Primary profession = other (specify)

Specify:

Person

2

N/A

Email (user name):

Person

2

N/A

Confirm email:

Person

2

N/A

Password:

Person

2

N/A

Confirm password:

Person

2

N/A

Do you wish to be
notified via email of
upcoming events or
other information.

Person

2

“Yes” / “No”

Security Question 1: Person

2

SecurityQuestions

Person

2

Security Question 2: Person

2

Person

2

Your answer:
Your answer:

N/A
SecurityQuestions
N/A

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3. Profession Specific Data
TCEO participants have the opportunity to update their account profile. The choices provided are based on the
primary profession selected. The specific data for each profession type are shown below in Figures 2a through
2f. The data element options for the profession specific data are shown in Table 2.

Figure 2a - Physician

Figure 2b – Nursing Professional

Figure 2c – Health Educator, Certified Health Education Specialist

Figure 2d – Health Educator, Master’s Certified Health Education Specialist

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Figure 2e – Pharmacist

Figure 2f - Veterinarian

Table 2—Profession Specific Data Elements
Display property

Column Label

Entity

Figure

List of Values

Work setting

Person

Same as above

Daytime phone

Person

Same as above

Education

Person

Same as above

Primary profession

Person

Same as above

If CEU or Audit credit type selected

N/A

N/A

4

If CME credit type selected

Specialty:

Person

4a

Specify:

Person

Specialty:

Person

Subspecialty:

Person

If CHES credit type selected

CHES number:

Person

4c

N/A

If MCHES credit type selected

MCHES number:

Person

4d

N/A

If CPE credit type selected

Specialty:

Person

4e

CPE ID number:

Person

Birthday:

Person

License number:

Person

Licensure state:

Person

If CNE credit type selected

If RACE credit type selected

N/A
CMESpecialty
N/A

4b

CNESpecialty
CNESubSpecialty

CPESpecialty
N/A
Month
Day

4f

N/A

State

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