Information Collection

Certified Nursing Assistants - Online Survey

IC 206594 under ICR 201304-0920-011 · OMB 0920-0983.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Certified Nursing Assistants - Online Survey	Form
Survey Web version Appendix M_(3).docx	Form
Appendix J_(3.docx Survey Instructions	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	none	Survey Web version	Appendix M_(3).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 149

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	149	149
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey Instructions	Appendix J_(3.docx	04/10/2013

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