Information Collection

Providers - State/Tribal - Trainees

IC 178433 under ICR 201308-0930-001 · OMB 0930-0286.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form D3 TUP-S Verbal Co Providers - State/Tribal - Trainees	Form and Instruction
D3 TUP-S Verbal Co D3 TUP-S Verbal Consent Script D9. TUP-S-6 Month Instrument and Verbal Consent.docx	Form and Instruction
D2. Training Utili D2. Training Utilization and Preservation Survey D2. Training Utilization and Preservation Survey_Consent to Contact Form_Formatted.docx	Form and Instruction
D9. TUP-S-6 Month D9. TUP-S-6 Month Instrument and Verbal Consent D9. TUP-S-6 Month Instrument and Verbal Consent.docx	Form and Instruction

IC Title:

Providers - State/Tribal - Trainees

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	D3 TUP-S Verbal Consent Script	D3 TUP-S Verbal Consent Script	D9. TUP-S-6 Month Instrument and Verbal Consent.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D2. Training Utilization and Preservation Survey	D2. Training Utilization and Preservation Survey	D2. Training Utilization and Preservation Survey_Consent to Contact Form_Formatted.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D9. TUP-S-6 Month Instrument and Verbal Consent	D9. TUP-S-6 Month Instrument and Verbal Consent	D9. TUP-S-6 Month Instrument and Verbal Consent.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,467

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,467	-388,421	391,888
Annual IC Time Burden (Hours)	395	-16,984	17,379
Annual IC Cost Burden (Dollars)	0	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.