Basic 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⚠️ Notice: This information collection may be referencing outdated material.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
Att 32 Basic Long-Term Evaluation -Screenshot.pdf Instruction
Att 31 Basic Long-Term Evaluation wordversion.docx Instruction

Information Collection (IC) Details

IC Title:	Basic 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
Instruction			Att 32 Basic Long-Term Evaluation -Screenshot.pdf		Yes	Yes	Fillable Printable
Instruction			Att 31 Basic Long-Term Evaluation wordversion.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Records of Health Professionals in Disease Prevention and Control Trainnig Programs	FR Citation: 51 FR 226

Number of Respondents: 50	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	50	50
Annual IC Time Burden (Hours)	2	2
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.