Information Collection

Dialysis Event Module Training Needs Assessment

IC 233228 under ICR 201711-0920-019 · OMB 0920-1071.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.