Information Collection

Tracking attendance of facilitation sessions

IC 237396 under ICR 202105-0935-001 · OMB 0935-0246.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form I Tracking attendance of facilitation sessions	Form and Instruction
I Tracking attendance of facilitation sessions Attachment I - Comprehensive List of clinical staff.docx	Form and Instruction
I Tracking attendance of facilitation sessions Attachment I - Comprehensive List of clinical staff.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	I	Tracking attendance of facilitation sessions	Attachment I - Comprehensive List of clinical staff.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 258

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: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,032	1,032
Annual IC Time Burden (Hours)	1,032	1,032
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.