Information Collection

Refresher Course Application

IC 184871 under ICR 202401-0920-010 · OMB 0920-0138.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0138 Refresher Course Application	Form and Instruction
Form 0920-0138 Attachment F Spirometry Refresher Course Application_2024 Refresher Course Application	Form and Instruction
0920-0138 Attachment F Spirometry Refresher Course Application_202 Attachment F Spirometry Refresher Course Application_2024.docx	Form and Instruction
0920-0138 Attachment F Spirometry Refresher Course Application_202 Attachment F Spirometry Refresher Course Application_2024.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-0138

Is this a Common Form? Yes

IC Status: Modified

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	0920-0138				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3	0	3
Annual IC Time Burden (Hours)	24	0	24
Annual IC Cost Burden (Dollars)	0	-552	552

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.

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