Information Collection

CDC Work@Health Trainee Technical Assistance Survey

IC 213479 under ICR 201410-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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
CDC Work@Health Trainee Technical Assistance Survey	Form and Instruction
CDC Work@Health Trainee Technical Assistance Survey Screenshot Attachment F-7_Trainee TA Survey.docx	Form and Instruction

IC Title:

CDC Work@Health Trainee Technical Assistance Survey

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
Form and Instruction	None	CDC Work@Health Trainee Technical Assistance Survey	Screenshot Attachment F-7_Trainee TA Survey.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 960

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	960	960
Annual IC Time Burden (Hours)	240	240
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.