CDC TRAIN Delayed Follow-up Evaluation Tool

[PHIC] Application for Training

Documents and Forms

Document Name Document Type
CDC TRAIN Delayed Follow-up Evaluation Tool Form and Instruction
CDC TRAIN Follow-Up Evaluation Tool Att5_CDCTRAIN_FollowUpEval.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CDC TRAIN Delayed Follow-up Evaluation Tool	Agency IC Tracking Number:	0920-0017

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 and Instruction	n/a	CDC TRAIN Follow-Up Evaluation Tool	Att5_CDCTRAIN_FollowUpEval.docx		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 Professionals in Disease Prevention and Control Training Programs	FR Citation: 51 FR 42449

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40,000	-50,000	90,000
Annual IC Time Burden (Hours)	2,000	-1,000	3,000
Annual IC Cost Burden (Dollars)	0	-146,160	146,160

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.