Information Collection Request

Rural Public Health Workforce Training Network Program (RPHWTN)

ICR 202305-0915-006 · OMB 0915-0392 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 4R Trainee Survey_Redline Form New Available
Form 4 Trainee Survey Form New Available
Form 4 Trainee Survey Form New Repair queued
Form 3 Grantee Exit Survey Form New Available
Form 3 Grantee Exit Survey Form New Repair queued
Form 2 Grantee Follow-up Survey Form New Available
Form 2 Grantee Follow-up Survey Form New Repair queued
Form 1 Grantee Baseline Survey Form New Available
Form 1 Grantee Baseline Survey Form New Repair queued
Supporting Statement A_RPHWNTP_Final 05082023.docx Supporting Statement A Uploaded 2023-05-30 Repair queued
Attachment6_M-21-20.pdf Supplementary Document Uploaded 2023-05-30 Repair queued
Attachment1_HRSA-22-117-RPHWTNP-NOFO.pdf Supplementary Document Uploaded 2023-05-30 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
260417 Trainee Survey Form NewTrainee Survey_Redline
260417 Trainee Survey Form NewTrainee Survey
260417 Trainee Survey Form New
260416 Grantee Exit Survey Form NewGrantee Exit Survey
260416 Grantee Exit Survey Form New
260415 Grantee Follow-up Survey Form NewGrantee Follow-up Survey
260415 Grantee Follow-up Survey Form New
260414 Grantee Baseline Survey Form NewGrantee Baseline Survey
260414 Grantee Baseline Survey Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2026 36 Months From Approved
1,128 0 0
274 0 0
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Grantee Baseline Survey 1
Grantee Exit Survey 3
Grantee Follow-up Survey 2
Trainee Survey 4, 4R ,  

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 1,128 0 0 1,096 32 0
Annual Time Burden (Hours) 274 0 0 266 8 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No