Follow-up Survey

Capacity Building Assistance Program: Data Management, Monitoring, and Evaluation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1322 can be found here:

Documents and Forms

Document Name Document Type
Follow-up Survey Form
Follow-up Survey Att 13_Training and TA Follow-up Survey-Screenshots.docx Form
Follow-up survey - word Att 12_Training and TA Follow-Up Survey-Word version.docx Form

Information Collection (IC) Details

IC Title:	Follow-up Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	none	Follow-up Survey	Att 13_Training and TA Follow-up Survey-Screenshots.docx		Yes	Yes	Fillable Fileable
Form	none	Follow-up survey - word	Att 12_Training and TA Follow-Up Survey-Word version.docx		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 Training Programs.	FR Citation: 51 FR 42485

Number of Respondents: 139	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	278	278
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	1,976	1,976

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.