Practicum Long-Term Evaluation

National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0995 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0995 Practicum Long-Term Evaluation Form and Instruction
0920-0995 Att 15 Practicum Long-Term Evaluation wordversion Att 15 Practicum Long-Term Evaluation wordversion.docx Form and Instruction
0920-0995 Att 16 Practicum 3-month Long-Term Evaluation -Screensho Att 16 Practicum 3-month Long-Term Evaluation -Screenshot.pdf Form

Information Collection (IC) Details

IC Title:	Practicum Long-Term Evaluation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0995	Att 15 Practicum Long-Term Evaluation wordversion	Att 15 Practicum Long-Term Evaluation wordversion.docx		Yes	Yes	Fillable Fileable
Form	0920-0995	Att 16 Practicum 3-month Long-Term Evaluation -Screenshot	Att 16 Practicum 3-month Long-Term Evaluation -Screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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