Information Collection

EHLR Immersion Community Engagement Module1_Knowledge Assessment

IC 261514 under ICR 202307-0923-001 · OMB 0923-0060.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0923-0060 EHLR Immersion Community Engagement Module1_Knowledge Assessment	Form and Instruction
0923-0060 EHLR Immersion Community Engagement Module Knowledge Ass Att5a-Mod01-EHLRImm (online) RSTw-Chg.pdf	Form and Instruction
0923-0060 EHLR Immersion Community Engagement Module Knowledge Ass Att5a-Mod01-EHLRImm (online) RSTw-Chg.pdf	Form and Instruction
Att5a-Mod01-EHLRImm (Word) RSTw-Chg.docx EHLR Immersion Community Engagement Module Knowledge Assessment	IC Document
Att5a-Mod01-EHLRImm (Word) RSTw-Chg.docx EHLR Immersion Community Engagement Module Knowledge Assessment	IC Document

IC Title:

Agency IC Tracking Number:

0923-0060

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0923-0060	EHLR Immersion Community Engagement Module Knowledge Assessment	Att5a-Mod01-EHLRImm (online) RSTw-Chg.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: 09-20-0161 Records of Health Professional in Disease Prevention and Control Training Programs, HHS/CDC/NCPS

FR Citation: 85 FR 6591

Number of Respondents: 125

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	125	25	100
Annual IC Time Burden (Hours)	31	23	8
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
EHLR Immersion Community Engagement Module Knowledge Assessment	Att5a-Mod01-EHLRImm (Word) RSTw-Chg.docx	08/09/2023

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