Information Collection

Promotores (client pre-test, post-test, and second post-tests for experimenta and control groups)

IC 208914 under ICR 201311-0925-003 · OMB 0925-0688.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Client pre-test, pot-test, and second post-tests for experimental control groups Promotores (client pre-test, post-test, and second post-tests for experimenta and control groups)	Form and Instruction
2 Client pre-test, pot-test, and second post-tests for exp Attachment 3 Client Pre-test and Post-test Survey.docx	Form and Instruction

IC Title:

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 and Instruction	2				No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	340	340
Annual IC Time Burden (Hours)	85	85
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.

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