Ethics Participant Feedback Form

Participant Feedback Forms for the Mental Health Care Provider Education (MHCPE) in the HIV/AIDS Program

Documents and Forms

Document Name Document Type
Form Forms in IC-1 Ethics Participant Feedback Form Form and Instruction
Forms in IC-1 Forms in IC-1 No instruments[2].doc Form and Instruction

Information Collection (IC) Details

IC Title:	Ethics Participant Feedback Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Forms in IC-1	Forms in IC-1	No instruments[2].doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	125	125
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.