Information Collection

CN Operators

IC 257718 under ICR 202211-0584-012 · OMB 0584-0678.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A- Sample State Agency Letter -1.docx	Other-
Appendix A- Sample State Agency Letter -1.docx	Other-
Appendix B- Nomination Form -1.docx	Other-
Appendix B- Nomination Form -1.docx	Other-
Appendix C- Welcome Questions -1.docx	Other-
Appendix C- Welcome Questions -1.docx	Other-
Appendix D- Course Evaluation -1.docx	Other-
Appendix D- Course Evaluation -1.docx	Other-
Appendix E- Program Impact Evaluation- 1.docx	Other-
Appendix E- Program Impact Evaluation- 1.docx	Other-

IC Title:

CN Operators

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-	Appendix A- Sample State Agency Letter -1.docx	Yes	Yes	Fillable Printable
Other-	Appendix B- Nomination Form -1.docx	Yes	Yes	Fillable Printable
Other-	Appendix C- Welcome Questions -1.docx	Yes	Yes	Fillable Printable
Other-	Appendix D- Course Evaluation -1.docx	Yes	Yes	Fillable Printable
Other-	Appendix E- Program Impact Evaluation- 1.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 155

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	379	379
Annual IC Time Burden (Hours)	94	94
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.