Information Collection

Bullying Prevention Training Modules Feedback Forms

IC 217671 under ICR 201502-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Bullying Prevention Training Modules Feedback Forms	Form and Instruction
1 Form A Bullying Prevention Online Program - 06232015.doc Form A Bullying Prevention Online Program - 06232015.docx	Form and Instruction
2 Form B Follow-Up Form For Participants in the Bullying P Form B Follow-Up Form For Participants in the Bullying Prevention Training Module 06232015.docx	Form and Instruction
RevisedHRSA Bullying Supporting Statement 062315.docx RevisedHRSA Bullying Supporting Statement 062315.docx	IC Document

IC Title:

Bullying Prevention Training Modules Feedback Forms

Agency IC Tracking Number:

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	1	Form A Bullying Prevention Online Program - 06232015.docx	Form A Bullying Prevention Online Program - 06232015.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Form B Follow-Up Form For Participants in the Bullying Prevention Training Module	Form B Follow-Up Form For Participants in the Bullying Prevention Training Module 06232015.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	500	500
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
RevisedHRSA Bullying Supporting Statement 062315.docx	RevisedHRSA Bullying Supporting Statement 062315.docx	07/28/2015

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