Dialysis Event Module Training Needs Assessment

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1071 Dialysis Event Module Training Needs Assessment Form and Instruction
0920-1071 The Dialysis Event Module Training Needs Assessment SurveyMonkey_OMB.pdf Form and Instruction
Service Delivery Fast Track Template_OMB.docx GenIC Request Template IC Document

Information Collection (IC) Details

IC Title:	Dialysis Event Module Training Needs Assessment	Agency IC Tracking Number:	0920-1071-18BCY

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	0920-1071	The Dialysis Event Module Training Needs Assessment	SurveyMonkey_OMB.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,500	6,500
Annual IC Time Burden (Hours)	1,083	1,083
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Template	Service Delivery Fast Track Template_OMB.docx	09/27/2018

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