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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0995 Basic Long-Term Evaluation Form and Instruction
0920-0995 Basic Long Term Evaluation Att 31 Basic Long Term Evaluation wordversion.docx Form and Instruction
0920-0995 Basic Long Term Evaluation screenshot Att 32 Basic Long Term Evaluation Screenshot.pdf Form

Information Collection (IC) Details

IC Title:	Basic Long-Term Evaluation	Agency IC Tracking Number:	0920-0995

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	0920-0995	Basic Long Term Evaluation	Att 31 Basic Long Term Evaluation wordversion.docx		Yes	Yes	Fillable Printable
Form	0920-0995	Basic Long Term Evaluation screenshot	Att 32 Basic Long Term Evaluation Screenshot.pdf		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	Previously Approved
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.