TCEO New Participant Registration

Application for Training

Attachment 4_ Appl for Trng_TCEO New Participant Registration

TCEO New Participant Registration

OMB: 0920-0017

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Attachment 5

Information Collection Instrument,

Training and Continuing Education Online New Participant Registration












TCEO New Participant Registration

2018



















Introduction


The purpose of this document is to list all data elements collected online from the learners that wish to obtain continuing education credit through the Centers for Disease Control and Prevention’s (CDC) Training and Continuing Education Online System (TCEO).


TCEO has a robust, flexible framework, and is successfully tailored for the various healthcare professions requiring continuing education for certification and licensure. This collection of data elements, derived from the Create Account and My Profile screens, makes up the TCEO New Participant Registration form.




Figure 1. Create Account Screen

To create an account in the Training and Continuing Education Online System (TCEO) participants are required to complete the data fields shown in the Create Account screen (Figure 1). The data element options to create an account are shown in Table 1.



Figure 1 – Create Account Screen (Top of Page 1)

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Exp. date changed from xx/xx/2016





Table 1 – Create Account Data Elements

Column Label

Display property

Figure

Email:


1

Confirm email:


1

Password:


1

Confirm password:


1

Do you wish to be notified by email of upcoming CDC training events or educational opportunities?

Y/N

1





Figure 2. My Profile

To complete creating an account in the Training and Continuing Education Online System (TCEO), participants are required to complete the data fields shown in the My Profile screen (Figure 2). The data element options to create an account are shown in Table 2.



Figure 2a – My Profile Screen (Middle of Page 1)

Shape6 Shape5

State/Territory” appears if “United States (and Territories)” is selected as country





Figure 2b – My Profile Screen (Bottom of Page 1)





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Shape23 Shape21 Shape22 Shape19 Shape20 Shape18 Shape13 Shape16 Shape17 Shape15 Shape14 Shape9 Shape8 Shape12 Shape10 Shape11

Removed “Academic”

New

New

New

New

New

New

Table 2 – My Profile Screen Data Elements

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New

Column Label

Display property

Shape29 Shape28 Shape27 Shape26 Shape25 Figure

First name:


2a & 2b

Middle initial:


2a & 2b

Last name:


2a & 2b

Address:


2a & 2b

City:


2a & 2b

Country:


2a & 2b

Specify: If US selected as country, then dropdown selection appears: “State/Territory”


2a & 2b

Zip/postal code:


2a & 2b

Do you have a United States telephone number?

Y/N

2a & 2b

Daytime telephone:


2a & 2b

Ext #


2a & 2b

Are you a CDC/ATSDR employee?

Y/N

2a & 2b

Are you in the United States Uniformed Services?

Y/N

2a & 2b

If so, what branch?


2a & 2b

Subspecialty:

US Army

2a & 2b

Subspecialty:

US Air Force

2a & 2b

Subspecialty:

US Marines

2a & 2b

Subspecialty:

US Navy

2a & 2b

Subspecialty:

US Coast Guard

2a & 2b

Subspecialty:

NOAH Commissioned Corps

2a & 2b

Subspecialty:

USPHS Commissioned Corps

2a & 2b

Are you a Physician?

Y/N

2a & 2b

Are you a Pharmacist?

Y/N

2a & 2b

Employer:


2a & 2b

Education:

Select:

2a & 2b

Specify:

Eighth grade or less

2a & 2b

Specify:

Some high school

2a & 2b

Specify:

High school graduate

2a & 2b

Specify:

Some college

2a & 2b

Specify:

Completed college (e.g., BA or BS)

2a & 2b

Specify:

Some graduate or professional school (requiring work beyond college graduation

2a & 2b

Specify:

Masters (e.g., MA, MPH, or MS)

2a & 2b

Specify:

JD

2a & 2b

Specify:

PhD, EdD, DrPH, PharmD, ScD, or equivalent

2a & 2b

Specify:

MD, DO, or equivalent

2a & 2b

Specify:

MD/PhD, MD/JD, or equivalent dual advanced degrees

2a & 2b

Specify:

Other education

2a & 2b

Work setting:

Select:

2a & 2b

Specify:

Educational Institution

2a & 2b

Subspecialty:

K-12

2a & 2b

Subspecialty:

Pre-K/Childcare

2a & 2b

Subspecialty:

University/Higher/Institution

2a & 2b

Specify:

Healthcare

2a & 2b

Subspecialty:

Behavioral/Mental Health Facility

2a & 2b

Subspecialty:

Clinical or Commercial Laboratory

2a & 2b

Subspecialty:

Diagnostic Imaging Center

Shape30 2a & 2b

Subspecialty:

Home Care

2a & 2b

Subspecialty:

Hospice

Shape31

New

2a & 2b

Subspecialty:

Hospital

2a & 2b

Subspecialty:

Nursing Home or Long Term Home Facility

2a & 2b

Subspecialty:

Outpatient Care Center

2a & 2b

Subspecialty:

Private Office or Clinic

2a & 2b

Subspecialty:

Rural/Community Health Center (or other Federally Qualified Health Center)

2a & 2b

Subspecialty:

School Health Clinic

2a & 2b

Subspecialty:

Other

Shape32 2a & 2b

Specify:

Indian Health Service

2a & 2b

Specify:

Non-profit Organization

2a & 2b

Specify:

Private Industry (except healthcare)

2a & 2b

Specify:

Public Health Agency

2a & 2b

Public health work setting:

Federal Public Health

2a & 2b

Public health work setting:

Local Public Health

Shape33

New


2a & 2b

Public health work setting:

Public Health Clinic

2a & 2b

Public health work setting:

Regional/Area Public Health

2a & 2b

Public health work setting:

State/Territory Public Health

2a & 2b

Specify:

Tribal Health Sites

2a & 2b

Specify:

Other Governmental Agency (except military)

2a & 2b

Specify:

Other Work Setting

2a & 2b

Primary profession:

Select:

2a & 2b

Specify:

Administrative Support Staff

2a & 2b

Specify:

Administrator/Director/Manager

Shape34 2a & 2b

Specify:

Allied Health Professional

2a & 2b

Subspecialty:

Dietician

2a & 2b

Subspecialty:

Medical Assistant

2a & 2b

Subspecialty:

Medical Imaging Professional

2a & 2b

Subspecialty:

Optician

2a & 2b

Subspecialty:

Rehabilitation Professional

2a & 2b

Subspecialty:

Respiratory Therapy Professional

2a & 2b

Subspecialty:

Speech, Language, Audiology Professional

2a & 2b

Specify:

Animal Handler

2a & 2b

Specify:

Biostatistician

2a & 2b

Specify:

Childcare Provider

2a & 2b

Specify:

Computer/Information Systems Specialists

2a & 2b

Specify:

Dental Professional

Shape36 Shape35

New

2a & 2b

Subspecialty:

Dental Assistant

2a & 2b

Subspecialty:

Dental Hygienist or Technical Assistant

2a & 2b

Subspecialty:

Dentist

2a & 2b

Subspecialty:

Other Dental Professional

2a & 2b

Specify:

Emergency Responder

2a & 2b

Subspecialty:

Emergency Medical Services Personnel

2a & 2b

Subspecialty:

Emergency Preparedness/Management Personnel

2a & 2b

Subspecialty:

Fire and Rescue Personnel

2a & 2b

Subspecialty:

Other Emergency Responder

Shape37 2a & 2b

Specify:

Environmental Health Professional

2a & 2b

Subspecialty:

Engineer/Engineering Technician

2a & 2b

Subspecialty:

Environmental Health Specialist/Sanitarian

2a & 2b

Subspecialty:

Food Safety Professional

2a & 2b

Subspecialty:

Hazardous Substance Professional

2a & 2b

Subspecialty:

Industrial Hygienist

2a & 2b

Subspecialty:

Radon Specialist

2a & 2b

Subspecialty:

Toxicologist

2a & 2b

Subspecialty:

Other Environmental Health

2a & 2b

Specify:

Epidemiologist/Infection Control/Communicable Disease Professional

2a & 2b

Specify:

Facility Manager/Engineer

2a & 2b

Specify:

Food Service/Housekeeping

2a & 2b

Specify:

Governmental Official

2a & 2b

Subspecialty:

Board of Health Member

2a & 2b

Subspecialty:

Other Elected Appointed Official (except Public Health)

2a & 2b

Specify:

Health Educator

2a & 2b

Specify:

Laboratory Professional/Technician

2a & 2b

Specify:

Law Enforcement

2a & 2b

Specify:

Legal Professional

2a & 2b

Specify:

Liberian/Information Specialist

2a & 2b

Specify:

Licensure/Inspection/Regulatory Specialist

2a & 2b

Specify:

Medical Examiner/Coroner

2a & 2b

Specify:

Mental and Behavioral Health Professional

Shape39 Shape38

Everything

on this page is new

2a & 2b

Subspecialty:

Marriage and Family Therapist

2a & 2b

Subspecialty:

Mental Health Counselor

2a & 2b

Subspecialty:

Other Mental or Behavioral Health

2a & 2b

Subspecialty:

Psychologist

2a & 2b

Subspecialty:

Social Worker

2a & 2b

Subspecialty:

Substance Abuse Counselor

2a & 2b

Specify:

Nursing Professional

2a & 2b

Subspecialty:

Advanced Practiced Nurse

2a & 2b

Specify:

Clinical Nurse Specialist

2a & 2b

Specify:

General

2a & 2b

Specify:

Nurse Anesthetist

2a & 2b

Specify:

Nurse Practitioner

2a & 2b

Specify:

Nurse Midwife

2a & 2b

Subspecialty:

Licensed Practical Nurse (LPN)/ Licensed Vocational Nurse (APRN)

2a & 2b

Subspecialty:

Registered Nurse

2a & 2b

Specify:

Administrator

2a & 2b

Specify:

Clinical Nurse

2a & 2b

Specify:

General

2a & 2b

Specify:

Infection Prevention

2a & 2b

Specify:

Mental and Behavioral Health Nurse

2a & 2b

Specify:

Nurse Educator

2a & 2b

Specify:

Public Health Nurse

2a & 2b

Specify:

Occupational Health and Safety Personnel

2a & 2b

Specify:

Outreach/Field Worker

2a & 2b

Specify:

Pharmacy Professional

2a & 2b

Subspecialty:

Pharmacist

2a & 2b

Subspecialty:

Pharmacy Technician/Aid

2a & 2b

Specify:

Physician

2a & 2b

Subspecialty:

Allergy/Immunology

2a & 2b

Subspecialty:

Anesthesiology

2a & 2b

Subspecialty:

Colon and Rectal Surgery

2a & 2b

Subspecialty:

Dermatology

2a & 2b

Subspecialty:

Emergency Medicine

2a & 2b

Subspecialty:

Family Practice

2a & 2b

Subspecialty:

Internal Medicine

2a & 2b

Subspecialty:

Medical Genetics

2a & 2b

Subspecialty:

Neurological Surgery

2a & 2b

Subspecialty:

Neurology

2a & 2b

Subspecialty:

Nuclear Medicine

2a & 2b

Subspecialty:

Obstetrics and Gynecology

2a & 2b

Subspecialty:

Ophthalmology

2a & 2b

Subspecialty:

Orthopedic Surgery

2a & 2b

Subspecialty:

Otolaryngology

2a & 2b

Subspecialty:

Pathology-Anatomic and Clinical

2a & 2b

Subspecialty:

Pediatrics

2a & 2b

Subspecialty:

Physical Medicine and Rehabilitation

2a & 2b

Subspecialty:

Plastic Surgery

2a & 2b

Subspecialty:

Preventive Medicine

2a & 2b

Subspecialty:

Psychiatry

2a & 2b

Subspecialty:

Radiation Oncology

2a & 2b

Subspecialty:

Radiology-Diagnostic

2a & 2b

Subspecialty:

Surgery-General

2a & 2b

Subspecialty:

Thoracic Surgery

2a & 2b

Subspecialty:

Urology

2a & 2b

Subspecialty:

Other

2a & 2b

Specify:

Policy Planner

2a & 2b

Specify:

Program Specialist

2a & 2b

Specify:

Public Health Official

2a & 2b

Specify:

Public Relations/Media/Communications Specialists

2a & 2b

Specify:

Researcher/Analyst

2a & 2b

Specify:

Student

2a & 2b

Specify:

Teacher/Faculty

2a & 2b

Specify:

Veterinarian

2a & 2b

Specify:

Volunteer

2a & 2b

Specify:

Other Medical Professional

2a & 2b

Specify:

Other Profession

2a & 2b

Subspecialty:

Chiropractor

2a & 2b

Subspecialty:

Optometrist

2a & 2b

Subspecialty:

Physician Assistant

2a & 2b

Subspecialty:

Podiatrist

2a & 2b

Subspecialty:

Other

2a & 2b

Specify:

Other Profession

2a & 2b

Security Question 1:


2a & 2b

Your answer:


2a & 2b

Security Question 2:


2a & 2b

Your answer:


2a & 2b

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New




Table 4 – Select CE Data Elements

Column Label

Display property

Figure

Select CE Type:


4

You must specify other profession. You must select a profession. You must select a specialty.


4

MY CE INFORMATION:


4

Specify:

CME (Physician) Information

4

Specify:

CME Type: (Dropdown: MBBS, DO, MD, Certificate of Participation)

4

Specify:

Physician MOC Information

4

Specify:

  • MOC ID:

4

Specify:

  • Birth Month:

4

Specify:

  • Birth Day:

4

Specify:

CHES (Certified Health Education Specialists) Information

4

Specify:

  • CHES Number:

4

Specify:

CPE (Pharmacists) Information

4

Specify:

  • CPE ID:

4

Specify:

  • Birth Month:

4

Specify:

  • Birth Day:

4

Specify:

AAVSB (Veterinarians) Information

4

Specify:

  • License Number (up to 2):

4

Specify:

  • State (up to 2)

4


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleTCEO New Participant Registration
AuthorArundar, Sonya (CDC/OSELS/SEPDPO) (CTR)
File Modified0000-00-00
File Created2021-01-15

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