3 Attendance Log

Your Program Name

OMB Control No. 0985-XXXX
Exp. Date XX/XX/201

Attendance Log
Instructions to the Group Leaders: Please clearly print the Workshop Information and the
Participant Names below. Write participants’ names as they appear on their Participant
Information Surveys.
Mark each session that the participant attends like this:
Implementation Site Name:
Start Date (mm/dd/yyyy): __ __/__ __/__ __ __ __ End Date (mm/dd/yyyy): __ __/__ __/__ __ __ __
Table 1: CDSMP Participant Attendance Log
Session Number
Participant Name

1

2

3

4

5

6

7
(PSMP
Only)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0985-xxx. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data
resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write
to: Administration for Community Living, 1 Massachusetts Avenue, N.W., Room 5203, Washington, D.C. 20001, Attention: PRA Reports Clearance Officer