Information Collection

CDC Work@Health Trainee Reaction Survey Hands-On Model

IC 209583 under ICR 201312-0920-004 · OMB 0920-1006.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1006 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att F-3_Work@Health Trainee Reaction Survey Hands-on Model.doc	Other-WORD

IC Title:

CDC Work@Health Trainee Reaction Survey Hands-On Model

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
Other-WORD			Att F-3_Work@Health Trainee Reaction Survey Hands-on Model.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 0920-0136 Epidemiologic Studies and Survelliance of DIsease Problems

FR Citation: 57 FR 62812

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	180	180
Annual IC Time Burden (Hours)	45	45
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.