Training and Technical Assistance Follow-up Survey

[NCHHSTP] Capacity Building Assistance Program: Data Management, Monitoring, and Evaluation

Documents and Forms

Document Name Document Type
Form 0920-1322 Training and Technical Assistance Follow-up Survey Form
0920-1322 Training and Technical Assistance Follow-up Survey Att 13_Training and TA Follow-up Survey-Screenshots.docx Form
0920-1322 Training and Technical Assistance Follow-up Survey Att 13_Training and TA Follow-up Survey-Screenshots.docx Form
0920-1322 Training and Technical Assistance Follow-up Survey - WOR Att 12_Training and TA Follow-Up Survey-Word version.docx Form
0920-1322 Training and Technical Assistance Follow-up Survey - WOR Att 12_Training and TA Follow-Up Survey-Word version.docx Form
Att 11_Training and TA Follow-up Survey Introductory Email.docx Training and Technical Assistance Follow-up Survey Introductory Email IC Document
Att 11_Training and TA Follow-up Survey Introductory Email.docx Training and Technical Assistance Follow-up Survey Introductory Email IC Document
Att 14_Training and TA Follow-up Survey-Reminder Email.docx Training and Technical Assistance Follow-up Survey Non-responder Reminder Email IC Document
Att 14_Training and TA Follow-up Survey-Reminder Email.docx Training and Technical Assistance Follow-up Survey Non-responder Reminder Email IC Document

Information Collection (IC) Details

IC Title:	Training and Technical Assistance Follow-up Survey	Agency IC Tracking Number:	0920-1322

Is this a Common Form? No		IC Status: Modified

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	0920-1322	Training and Technical Assistance Follow-up Survey	Att 13_Training and TA Follow-up Survey-Screenshots.docx		Yes	Yes	Fillable Fileable
Form	0920-1322	Training and Technical Assistance Follow-up Survey - WORD	Att 12_Training and TA Follow-Up Survey-Word version.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Records of Health Professionals in Disease Prevention and Control Training Programs.	FR Citation: 51 FR 42485

Number of Respondents: 139	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 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	278	278
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Training and Technical Assistance Follow-up Survey Introductory Email	Att 11_Training and TA Follow-up Survey Introductory Email.docx	08/01/2024
Training and Technical Assistance Follow-up Survey Non-responder Reminder Email	Att 14_Training and TA Follow-up Survey-Reminder Email.docx	08/01/2024

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