Maternal and Child Health Epidemiology Training Course One-Year Follow-up Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Maternal and Child Health Epidemiology Training Course One-Year Follow-up Survey Form
1 One-Year Trainee Survey form.docx One-Year Trainee Survey form.docx Form
Supporting Statement - one-year trainee survey.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Maternal and Child Health Epidemiology Training Course One-Year Follow-up Survey	Agency IC Tracking Number:

IC Status: Unchanged

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	1	One-Year Trainee Survey form.docx	One-Year Trainee Survey form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Supporting Statement - one-year trainee survey.docx	08/08/2018

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