[ATSDR] Environmental Health and Land Reuse (EHLR) Immersion Training Pilots

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
[ATSDR] Environmental Health and Land Reuse (EHLR) Immersion Training Pilots Form and Instruction
AttA-EHLR-Pilot-TrainingRegistForm (Word).docx Other-WORD
ATT-B-EHLRImm-KnowlAssmt-Pilot (Word).docx Other-WORD
AttC-EHLR-Pilot-FeedbkForm (Word).docx Other-WORD
EHLR Training Registration-Pilots ATT-A-EHLRT-Pilot RegistFrm (REDCap).pdf Form and Instruction
EHLR Immersion Community Engagement Knowledge Assessment ATT-B-EHLRImm-KnowlAssmt-Pilot (REDCap).pdf Form and Instruction
EHLR Immersion Pilot Training Feedback Form AttC-EHLR-Pilot-FeedbkForm (REDCap).pdf Form and Instruction
GenIC-EHLR-Immersion-Pilot.docx GenIC Request Template (Project Description and Justification for EHLR Training Pilots Feedback) IC Document
AttD-STARS Determination-EHLR.pdf CDC Determination: IRB Approval is Not Required IC Document

Information Collection (IC) Details

IC Title:	[ATSDR] Environmental Health and Land Reuse (EHLR) Immersion Training Pilots	Agency IC Tracking Number:	0923-23CT

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	EHLR Training Registration-Pilots	ATT-A-EHLRT-Pilot RegistFrm (REDCap).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	None	EHLR Immersion Community Engagement Knowledge Assessment	ATT-B-EHLRImm-KnowlAssmt-Pilot (REDCap).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	None	EHLR Immersion Pilot Training Feedback Form	AttC-EHLR-Pilot-FeedbkForm (REDCap).pdf	Yes	Yes	Fillable Fileable
Other-WORD			AttA-EHLR-Pilot-TrainingRegistForm (Word).docx	No		Printable Only
Other-WORD			ATT-B-EHLRImm-KnowlAssmt-Pilot (Word).docx	No		Printable Only
Other-WORD			AttC-EHLR-Pilot-FeedbkForm (Word).docx	No		Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: CDC/ATSDR Trainee Records (SORN 09-20-0161)	FR Citation: 86 FR 16212

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	47	47
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Template (Project Description and Justification for EHLR Training Pilots Feedback)	GenIC-EHLR-Immersion-Pilot.docx	02/17/2023
CDC Determination: IRB Approval is Not Required	AttD-STARS Determination-EHLR.pdf	02/17/2023

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