Information Collection

MIECHV CQI Practicum, Mid-Practicum Feedback Questions

IC 227009 under ICR 201502-0970-004 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CQI Practicum satisfaction survey 5.25 pg.docx	Other-Survey
Fast Track Generic - Submission Template_CQI Practicum 05.24.doc MIECHV CQI Practicum - Fast Track Generic Submission Form	IC Document

IC Title:

MIECHV CQI Practicum, Mid-Practicum Feedback Questions

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
Other-Survey			CQI Practicum satisfaction survey 5.25 pg.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MIECHV CQI Practicum - Fast Track Generic Submission Form	Fast Track Generic - Submission Template_CQI Practicum 05.24.doc	05/26/2017

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