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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.