Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit_Registration and Evaluation

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCIRD)

Documents and Forms

Document Name Document Type
Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit_Registration and Evaluation Form
Registration Attachment A_Preparing HCW to Work in ETUs in Africa Training Toolkit_Registration Questionnaire.pdf Form
Evaluation Attachment B_Preparing HCW to Work in ETUs in Africa Training Toolkit_Evaluation Survey.pdf Form
Attachment C_Reminder Email_Incomplete Registration.docx Reminder Email for Incomplete Registration IC Document
Attachment D_Registration Complete_Thank You Email.docx Registration Complete Email IC Document
Attachment E_Toolkit Availability Email Notification.docx Toolkit Availability Email Notification IC Document
Attachment F_Invitation Email for Evaluation Survey.docx Evaluation Email Invitation IC Document
Attachment G_Reminder Email_Incomplete Evaluation Survey.docx Reminder Email Imcomplete Evaluation IC Document
GenIC 0920-1026_CDC Ebola ETU Toolkit_Registration and Evaluation Surveys_Final.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit_Registration and Evaluation	Agency IC Tracking Number:	15IX

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	none	Registration	Attachment A_Preparing HCW to Work in ETUs in Africa Training Toolkit_Registration Questionnaire.pdf		Yes	Yes	Fillable Fileable
Form	none	Evaluation	Attachment B_Preparing HCW to Work in ETUs in Africa Training Toolkit_Evaluation Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,300	1,300
Annual IC Time Burden (Hours)	370	370
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Reminder Email for Incomplete Registration	Attachment C_Reminder Email_Incomplete Registration.docx	01/12/2015
Registration Complete Email	Attachment D_Registration Complete_Thank You Email.docx	01/12/2015
Toolkit Availability Email Notification	Attachment E_Toolkit Availability Email Notification.docx	01/12/2015
Evaluation Email Invitation	Attachment F_Invitation Email for Evaluation Survey.docx	01/12/2015
Reminder Email Imcomplete Evaluation	Attachment G_Reminder Email_Incomplete Evaluation Survey.docx	01/12/2015
Request for Approval	GenIC 0920-1026_CDC Ebola ETU Toolkit_Registration and Evaluation Surveys_Final.docx	01/12/2015

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