Information Collection

State Chronic Disease Prevention and Control Programs: Training Needs

IC 218009 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
State Chronic Disease Prevention and Control Programs: Training Needs	Form and Instruction
Contact Instrument - NCCDPHP Training Needs Assessment C Contact Instrument.docx	Form and Instruction
Survey - NCCDPHP Training Needs Assessment E Instrument Web version.docx	Form and Instruction
Att. A Core Competencies.pdf NCCDPHP Core Competencies	IC Document
Att. B The Four Domains.pdf Four Domains of Chronic Disease Prevention	IC Document
D Instrument Word version.docx Survey - NCCDPHP Training Needs Assessment WORD	IC Document
F Invitation email.docx Invitation Email	IC Document
G Reminder email.doc Reminder Email	IC Document
SHD-TTASNA-SSA 31AUG.docx Supporting Statement A	IC Document
SHD-TTASNA-SSB 31AUG.docx Supporting Statement B	IC Document

IC Title:

State Chronic Disease Prevention and Control Programs: Training Needs

Agency IC Tracking Number:

15BEJ

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	NA	Contact Instrument - NCCDPHP Training Needs Assessment	C Contact Instrument.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	Survey - NCCDPHP Training Needs Assessment	E Instrument Web version.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 357

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	357	357
Annual IC Time Burden (Hours)	156	156
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NCCDPHP Core Competencies	Att. A Core Competencies.pdf	08/26/2015
Four Domains of Chronic Disease Prevention	Att. B The Four Domains.pdf	08/26/2015
Survey - NCCDPHP Training Needs Assessment WORD	D Instrument Word version.docx	08/26/2015
Invitation Email	F Invitation email.docx	08/26/2015
Reminder Email	G Reminder email.doc	08/26/2015
Supporting Statement A	SHD-TTASNA-SSA 31AUG.docx	08/31/2015
Supporting Statement B	SHD-TTASNA-SSB 31AUG.docx	08/31/2015

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