Information Collection

Attachment E: Secondary Trainee One-time 12-month Survey

IC 212070 under ICR 201406-0935-001 · OMB 0935-0220.

Documents and Forms

Document Name Document Type
Form 5 Attachment E: Secondary Trainee One-time 12-month Survey Form and Instruction
5 Attachment E: Secondary Trainee One-time 12-month Survey ATTACHMENT E_Survey5-Secondary Trainee One-time 6-24-14.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment E: Secondary Trainee One-time 12-month Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	5	Attachment E: Secondary Trainee One-time 12-month Survey	ATTACHMENT E_Survey5-Secondary Trainee One-time 6-24-14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	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	3,000	3,000
Annual IC Time Burden (Hours)	500	500
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.