National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Intensive Long-Term Evaluation	Form and Instruction	New	Repair queued
Intensive Long-Term Evaluation	Form and Instruction	New	Repair queued
Intensive Post-Course Evaluation	Form and Instruction	New	Repair queued
Intensive Post-Course Evaluation	Form and Instruction	New	Repair queued
Standard Long-Term Evaluation	Form and Instruction	New	Available
Standard Long-Term Evaluation	Form and Instruction	New	Repair queued
Standard Post-Course Evaluation	Form and Instruction	New	Available
Standard Post-Course Evaluation	Form and Instruction	New	Available
Form 0920-0995 Basic Post Course Evaluation screenshot	Form	Removed	Available
Form 0920-0995 Basic Post Course Evaluation	Form and Instruction	Removed	Available
Form 0920-0995 Basic Post Course Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Basic Long Term Evaluation screenshot	Form	Removed	Available
Form 0920-0995 Basic Long Term Evaluation	Form and Instruction	Removed	Available
Form 0920-0995 Basic Long-Term Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 STD Tx Guidelines Short Long-Term Evaluation -Screenshot	Form	Removed	Repair queued
Form 0920-0995 STD Tx Guidelines Short Long-Term Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Short Guidelines Long-Term Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 STD Tx Guidelines Short Post-Course Evaluation -Screenshot	Form	Removed	Repair queued
Form 0920-0995 STD Tx Guidelines Short Post-Course Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Short Guidelines Post-Course Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 STD Tx Guidelines Complete Long-Term Evaluation screenshot	Form	Removed	Repair queued
Form 0920-0995 STD Tx Guidelines Complete Long-Term Evaluation	Form and Instruction	Removed	Available
Form 0920-0995 STD Treatment Guidelines Complete Long-Term Evaluation	Form and Instruction	Removed	Available
Form 0920-0995 STD Tx Guidelines Complete Post-Course Evaluation screenshot	Form	Removed	Available
Form 0920-0995 STD Tx Guidelines Complete Post-course Evaluation	Form and Instruction	Removed	Available
Form 0920-0995 STD Treatment Guidelines Complete Post -Course Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Wet Mount Long Term Evaluation -Screenshot	Form	Removed	Available
Form 0920-0995 Wet Mount Long-Term wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Wet Mount Long-Term Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Wet Mount Post-Course Evaluation -Screenshot	Form	Removed	Repair queued
Form 0920-0995 Wet Mount Post-Course Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Wet Mount Post-Course Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Practicum 3-month Long-Term Evaluation -Screenshot	Form	Removed	Available
Form 0920-0995 Practicum Long-Term Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Practicum Long-Term Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Practicum Post-Course Evaluation -Screenshot	Form	Removed	Available
Form 0920-0995 Practicum Post-Course Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Practicum Post-Course Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Intensive Didactic Long-Term Evaluation -Screenshot	Form	Removed	Available
Form 0920-0995 Intensive Didactic Long-Term Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Intensive-Didactic Long-Term Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Intensive Didactic Post-Course Evaluation – Screenshot	Form	Removed	Available
Form 0920-0995 Intensive Didactic Post-Course Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Intensive-Didactic Post Course Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Intensive Complete Long-Term Evaluation -Screenshot	Form	Removed	Available
Form 0920-0995 Intensive Complete Long-Term Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Intensive Complete Long-Term Evaluation	Form and Instruction	Removed	Repair queued
Form 0920-0995 Intensive Complete Post-Course Evaluation -Screenshot	Form	Removed	Available
Form 0920-0995 Intensive Complete Post-Course Evaluation wordversion	Form and Instruction	Removed	Available
Form 0920-0995 Intensive Complete Post-Couse Evaluation	Form and Instruction	Removed	Repair queued
NNPTC Abbreviated Health Professional Application for Training	Form and Instruction	Modified	Available
NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	Form and Instruction	Modified	Repair queued
0920-0995 Change Request_02222022.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-02-22	Repair queued
SupSta A final.docx	Supporting Statement A	Uploaded 2020-04-03	Repair queued
Performance Measures STD Prevention OMB PRA Privacy Act Checklist Template 0920-0995.docx	Supplementary Document	Uploaded 2020-03-30	Repair queued
CDC_PRA_Determination_Form 0920 0995.pdf	Supplementary Document	Uploaded 2020-03-30	Repair queued
Att 39 Evaluation questions by instrument.xlsx	Supplementary Document	Uploaded 2020-03-30	Repair queued
Att 38 Table with Description of Attachments.docx	Supplementary Document	Uploaded 2020-03-30	Available
Att 37 Project Determination.pdf	Supplementary Document	Uploaded 2020-03-30	Repair queued
Att 3c Table of revisions to HPAT wordversion + cover sheet.docx	Supplementary Document	Uploaded 2020-03-30	Repair queued
Att 2 60 Day FRN Published 110419.pdf	Supplementary Document	Uploaded 2020-03-30	Repair queued
Att 1 Authorizing Legislation Section 301 PHSA.docx	Supplementary Document	Uploaded 2020-03-30	Available
SupSta B 0920-0995.docx	Supporting Statement B	Uploaded 2020-03-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
251729	Intensive Long-Term Evaluation	Form and Instruction	New	Intensive Long-Term Evaluation
251729	Intensive Long-Term Evaluation	Form and Instruction	New
251728	Intensive Post-Course Evaluation	Form and Instruction	New	Intensive Post-Course Evaluation
251728	Intensive Post-Course Evaluation	Form and Instruction	New
251727	Standard Long-Term Evaluation	Form and Instruction	New	Standard Long-Term Evaluation
251727	Standard Long-Term Evaluation	Form and Instruction	New
251726	Standard Post-Course Evaluation	Form and Instruction	New	Standard Post-Course Evaluation
251726	Standard Post-Course Evaluation	Form and Instruction	New
241012	Basic Post Course Evaluation	Form	Removed	Basic Post Course Evaluation screenshot
241012	Basic Post Course Evaluation	Form and Instruction	Removed	Basic Post Course Evaluation
241012	Basic Post Course Evaluation	Form and Instruction	Removed
225770	3 Month Long-Term Email Invitation	Instruction	Unchanged
225769	Immediate Post-Course Email Invitation	Instruction	Unchanged
225768	Basic Long-Term Evaluation	Form	Removed	Basic Long Term Evaluation screenshot
225768	Basic Long-Term Evaluation	Form and Instruction	Removed	Basic Long Term Evaluation
225768	Basic Long-Term Evaluation	Form and Instruction	Removed
225767	Short Guidelines Long-Term Evaluation	Form	Removed	STD Tx Guidelines Short Long-Term Evaluation -Screenshot
225767	Short Guidelines Long-Term Evaluation	Form and Instruction	Removed	STD Tx Guidelines Short Long-Term Evaluation wordversion
225767	Short Guidelines Long-Term Evaluation	Form and Instruction	Removed
225766	Short Guidelines Post-Course Evaluation	Form	Removed	STD Tx Guidelines Short Post-Course Evaluation -Screenshot
225766	Short Guidelines Post-Course Evaluation	Form and Instruction	Removed	STD Tx Guidelines Short Post-Course Evaluation wordversion
225766	Short Guidelines Post-Course Evaluation	Form and Instruction	Removed
225765	STD Treatment Guidelines Complete Long-Term Evaluation	Form	Removed	STD Tx Guidelines Complete Long-Term Evaluation screenshot
225765	STD Treatment Guidelines Complete Long-Term Evaluation	Form and Instruction	Removed	STD Tx Guidelines Complete Long-Term Evaluation
225765	STD Treatment Guidelines Complete Long-Term Evaluation	Form and Instruction	Removed
225764	STD Treatment Guidelines Complete Post -Course Evaluation	Form	Removed	STD Tx Guidelines Complete Post-Course Evaluation screenshot
225764	STD Treatment Guidelines Complete Post -Course Evaluation	Form and Instruction	Removed	STD Tx Guidelines Complete Post-course Evaluation
225764	STD Treatment Guidelines Complete Post -Course Evaluation	Form and Instruction	Removed
225763	Wet Mount Long-Term Evaluation	Form	Removed	Wet Mount Long Term Evaluation -Screenshot
225763	Wet Mount Long-Term Evaluation	Form and Instruction	Removed	Wet Mount Long-Term wordversion
225763	Wet Mount Long-Term Evaluation	Form and Instruction	Removed
225762	Wet Mount Post-Course Evaluation	Form	Removed	Wet Mount Post-Course Evaluation -Screenshot
225762	Wet Mount Post-Course Evaluation	Form and Instruction	Removed	Wet Mount Post-Course Evaluation wordversion
225762	Wet Mount Post-Course Evaluation	Form and Instruction	Removed
225748	Practicum Long-Term Evaluation	Form	Removed	Practicum 3-month Long-Term Evaluation -Screenshot
225748	Practicum Long-Term Evaluation	Form and Instruction	Removed	Practicum Long-Term Evaluation wordversion
225748	Practicum Long-Term Evaluation	Form and Instruction	Removed
225747	Practicum Post-Course Evaluation	Form	Removed	Practicum Post-Course Evaluation -Screenshot
225747	Practicum Post-Course Evaluation	Form and Instruction	Removed	Practicum Post-Course Evaluation wordversion
225747	Practicum Post-Course Evaluation	Form and Instruction	Removed
225745	Intensive-Didactic Long-Term Evaluation	Form	Removed	Intensive Didactic Long-Term Evaluation -Screenshot
225745	Intensive-Didactic Long-Term Evaluation	Form and Instruction	Removed	Intensive Didactic Long-Term Evaluation wordversion
225745	Intensive-Didactic Long-Term Evaluation	Form and Instruction	Removed
225742	Intensive-Didactic Post Course Evaluation	Form	Removed	Intensive Didactic Post-Course Evaluation – Screenshot
225742	Intensive-Didactic Post Course Evaluation	Form and Instruction	Removed	Intensive Didactic Post-Course Evaluation wordversion
225742	Intensive-Didactic Post Course Evaluation	Form and Instruction	Removed
225741	Intensive Complete Long-Term Evaluation	Form	Removed	Intensive Complete Long-Term Evaluation -Screenshot
225741	Intensive Complete Long-Term Evaluation	Form and Instruction	Removed	Intensive Complete Long-Term Evaluation wordversion
225741	Intensive Complete Long-Term Evaluation	Form and Instruction	Removed
225738	Intensive Complete Post-Couse Evaluation	Form	Removed	Intensive Complete Post-Course Evaluation -Screenshot
225738	Intensive Complete Post-Couse Evaluation	Form and Instruction	Removed	Intensive Complete Post-Course Evaluation wordversion
225738	Intensive Complete Post-Couse Evaluation	Form and Instruction	Removed
208451	NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	Form and Instruction	Modified	NNPTC Abbreviated Health Professional Application for Training
208451	NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0995	ICR Reference No: 202202-0920-013
Status: Historical Active	Previous ICR Reference No: 202003-0920-018
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0995
Title: National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/04/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/23/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2023	06/30/2023	06/30/2023
Responses	11,680	0	11,769
Time Burden (Hours)	453	0	502
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this data collection is to support program management of the National Network of Sexually Transmitted Disease Clinical Prevention Training Center (NNPTC) and to evaluate the reach and impact of the NNPTC's training activities. The purpose of this Change Request (submitted February 2022) is to consolidate forms across activities. This consolidation will support a unified evaluation plan.

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Authorizing Statute(s): PL: Pub.L. 42 - 792 776 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 59381	11/04/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 18982	04/03/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
3 Month Long-Term Email Invitation
Basic Long-Term Evaluation	0920-0995, 0920-0995	Basic Long Term Evaluation ,   Basic Long Term Evaluation screenshot
Basic Post Course Evaluation	0920-0995, 0920-0995	Basic Post Course Evaluation ,   Basic Post Course Evaluation screenshot
Immediate Post-Course Email Invitation
Intensive Complete Long-Term Evaluation	0920-0995, 0920-0995	Intensive Complete Long-Term Evaluation wordversion ,   Intensive Complete Long-Term Evaluation -Screenshot
Intensive Complete Post-Couse Evaluation	0920-0995, 0920-0995	Intensive Complete Post-Course Evaluation wordversion ,   Intensive Complete Post-Course Evaluation -Screenshot
Intensive Long-Term Evaluation	None	Intensive Long-Term Evaluation
Intensive Post-Course Evaluation	None	Intensive Post-Course Evaluation
Intensive-Didactic Long-Term Evaluation	0920-0995, 0920-0995	Intensive Didactic Long-Term Evaluation wordversion ,   Intensive Didactic Long-Term Evaluation -Screenshot
Intensive-Didactic Post Course Evaluation	0920-0995, 0920-0995	Intensive Didactic Post-Course Evaluation wordversion ,   Intensive Didactic Post-Course Evaluation – Screenshot
NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	None	NNPTC Abbreviated Health Professional Application for Training
Practicum Long-Term Evaluation	0920-0995, 0920-0995	Practicum Long-Term Evaluation wordversion ,   Practicum 3-month Long-Term Evaluation -Screenshot
Practicum Post-Course Evaluation	0920-0995, 0920-0995	Practicum Post-Course Evaluation wordversion ,   Practicum Post-Course Evaluation -Screenshot
STD Treatment Guidelines Complete Long-Term Evaluation	0920-0995, 0920-0995	STD Tx Guidelines Complete Long-Term Evaluation ,   STD Tx Guidelines Complete Long-Term Evaluation screenshot
STD Treatment Guidelines Complete Post -Course Evaluation	0920-0995, 0920-0995	STD Tx Guidelines Complete Post-course Evaluation ,   STD Tx Guidelines Complete Post-Course Evaluation screenshot
Short Guidelines Long-Term Evaluation	0920-0995, 0920-0995	STD Tx Guidelines Short Long-Term Evaluation wordversion ,   STD Tx Guidelines Short Long-Term Evaluation -Screenshot
Short Guidelines Post-Course Evaluation	0920-0995, 0920-0995	STD Tx Guidelines Short Post-Course Evaluation wordversion ,   STD Tx Guidelines Short Post-Course Evaluation -Screenshot
Standard Long-Term Evaluation	None	Standard Long-Term Evaluation
Standard Post-Course Evaluation	None	Standard Post-Course Evaluation
Wet Mount Long-Term Evaluation	0920-0995, 0920-0995	Wet Mount Long-Term wordversion ,   Wet Mount Long Term Evaluation -Screenshot
Wet Mount Post-Course Evaluation	0920-0995, 0920-0995	Wet Mount Post-Course Evaluation wordversion ,   Wet Mount Post-Course Evaluation -Screenshot

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	11,680	11,769	0	-89	0	0
Annual Time Burden (Hours)	453	502	0	-49	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The purpose of this Change Request (submitted February 2022) is to consolidate forms across activities. This consolidation will support a unified evaluation plan, by type of evaluation. In the majority of instances, burden per response will be reduced.

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Annual Cost to Federal Government: $102,783

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/23/2022

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