Information Collection

Baseline Information Form

IC 252823 under ICR 202203-1290-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PHE QED Baseline Information Form_June2022_clean.docx	Other-Information form
PHE QED Baseline Information Form_June2022_clean.docx	Other-Information form
PHE QED Participant Consent Form_June2022_clean.docx Participant consent form	IC Document
PHE QED Participant Consent Form_June2022_clean.docx Participant consent form	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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
Other-Information form			PHE QED Baseline Information Form_June2022_clean.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: 833

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	833	833
Annual IC Time Burden (Hours)	208	208
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Participant consent form	PHE QED Participant Consent Form_June2022_clean.docx	07/08/2022

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