Information Collection

Training and Technical Assistance Follow-up Survey

IC 242740 under ICR 202407-0920-005 · OMB 0920-1322.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-1322

Is this a Common Form? No

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.