Web-based seminar evaluations

Technical Assistance for Health IT and Health Information Exchange in Medicaid and SCHIP

Documents and Forms

Document Name Document Type
Form Form #3 Web-based seminar evaluations Form and Instruction
Form #3 Web-based seminar evaluations Attachment E_Webinar Evaluation Form_final.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Web-based seminar evaluations	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	Form #3	Web-based seminar evaluations	Attachment E_Webinar Evaluation Form_final.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	104	104
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.