Information Collection

Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment

IC 213921 under ICR 201403-0925-009 · OMB 0925-0701.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0701 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Survey Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment	Form and Instruction
1 Healthy Native Babies Project Train-the-Trainer Follow-U Attachment 1_0925-0701_Healthy Native Babies_Train-the-Trainer Survey.DOCX	Form and Instruction
GC Form_Healthy Native Babies_Train-the-Trainer Survey_rev 10-28-14.doc Generic Clearance Form Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment	IC Document
0925-0701_Sub-study Memo_Healthy Native Babies_Train-the-Trainer Survey_rev 10-28-14.docx Cover Memo Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment	IC Document

IC Title:

Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment

Agency IC Tracking Number:

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 and Instruction	1	Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Survey	Attachment 1_0925-0701_Healthy Native Babies_Train-the-Trainer Survey.DOCX		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 63

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	63	63
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance Form Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment	GC Form_Healthy Native Babies_Train-the-Trainer Survey_rev 10-28-14.doc	11/17/2014
Cover Memo Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment	0925-0701_Sub-study Memo_Healthy Native Babies_Train-the-Trainer Survey_rev 10-28-14.docx	11/17/2014

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