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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.