Information Collection

Client Group (pre-test, post-test, second post-tests for experimental and control groups)

IC 208915 under ICR 201311-0925-003 · OMB 0925-0688.

Documents and Forms

Document Name Document Type
Form 2 Client Group (pre-test, post-test, second post-tests for experimental 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Client Group (pre-test, post-test, second post-tests for experimental and control groups)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Client pre-test, pot-test, and second post-tests for experimental control group	Attachment 3 Client Pre-test and Post-test Survey.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 85	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	14	14
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.