Form 1 DATA CoIIN_ Post-TA Webinar Evaluation Survey

An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The
OMB control number for this project is 0915-xxxx. Public reporting burden for this
collection of information is estimated to average xx hours per response, including the
time for reviewing instructions, searching existing data sources, and completing and
reviewing the collection of information. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing
this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N-39,
Rockville, Maryland, 20857.

OMB Number (0915-XXXX) Expiration Date (XX/XX/201X)

OMB Number (0915-XXXX) Expiration Date (XX/XX/201X)

Thank you for your time and participation!

OMB Number (0915-XXXX) Expiration Date (XX/XX/201X)