Information Collection

Maternal and Child Health Epidemiology Training Course - One Year Follow-Up Survey

IC 222409 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⚠️ Notice: This information collection may be referencing outdated material.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 Maternal and Child Health Epidemiology Training Course - One Year Follow-Up Survey	Form
1 One-Year Trainee Survey form One-Year Trainee Survey form.docx	Form
Supporting Statement.docx Supporting Statement	IC Document

IC Title:

Maternal and Child Health Epidemiology Training Course - One Year Follow-Up Survey

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	1	One-Year Trainee Survey form	One-Year Trainee Survey form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

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	40	40
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting Statement.docx	07/12/2016

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