Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation

Documents and Forms

Document Name Document Type
RETAIN Baseline Participant Form Part 2, revised for Phase 2.docx Other-Survey
RETAIN Baseline Participant Form Part 1, revised for Phase 2 and Privacy Act Statement.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Retaining Employment and Talent after Injury/Illness Network (RETAIN) Demonstration Projects and Evaluation	Agency IC Tracking Number:	201803-0320-001

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			RETAIN Baseline Participant Form Part 2, revised for Phase 2.docx		Yes	Yes	Fillable Fileable
Other-Survey			RETAIN Baseline Participant Form Part 1, revised for Phase 2 and Privacy Act Statement.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,313	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,313	-20	5,333
Annual IC Time Burden (Hours)	1,771	-7	1,778
Annual IC Cost Burden (Dollars)	0	-146,817	146,817

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.