The Training Program Comparison Group Screener

Evaluation of Programs Supporting the Mental Health of the Health Professions Workforce

Documents and Forms

Document Name Document Type
Form 1 The Training Program Comparison Group Screener Form and Instruction
1 Healthcare Workforce Screener and Survey_6.5.23_clean 1. Healthcare Workforce Screener and Survey_6.5.23_clean.docx Form and Instruction
1 Healthcare Workforce Screener and Survey_6.5.23_clean 1. Healthcare Workforce Screener and Survey_6.5.23_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	The Training Program Comparison Group Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Healthcare Workforce Screener and Survey_6.5.23_clean	1. Healthcare Workforce Screener and Survey_6.5.23_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180,000	Number of Respondents for Small Entity: 46,800

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180,000	180,000
Annual IC Time Burden (Hours)	9,000	9,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.