Information Collection

Attachment D - Health Care Professionals Pre-/Post-Training Quiz

IC 213540 under ICR 201410-0935-002 · OMB 0935-0228.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Attachment D - Health Care Professionals Pre-/Post-Training Quiz	Form and Instruction
2 Attachment D - Health Care Professionals Pre-/Post-Train Attachment D - Health Care Professional Pre Training Quiz FINAL.docx	Form and Instruction

IC Title:

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	2	Attachment D - Health Care Professionals Pre-/Post-Training Quiz	Attachment D - Health Care Professional Pre Training Quiz FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 512

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	1,024	1,024
Annual IC Time Burden (Hours)	341	341
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.