Follow up Survey Assessment of CME Participants

Assessing the Feasibility of Disseminating Effective Health Center Products through Educational Activities

Documents and Forms

Document Name Document Type
Form Form #5 Follow up Survey Assessment of CME Participants Form
Form #5 Follow-up survey assessment for CME participants Attachment E -- Follow-up survey assessment for CME participants.docx Form
Attachment F -- Email invitation for follow-up survey assessment.doc Attachment F -- Email invitation for follow-up survey assessment IC Document

Information Collection (IC) Details

IC Title:	Follow up Survey Assessment of CME Participants	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	Form #5	Follow-up survey assessment for CME participants	Attachment E -- Follow-up survey assessment for CME participants.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,500	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: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment F -- Email invitation for follow-up survey assessment	Attachment F -- Email invitation for follow-up survey assessment.doc	02/08/2012

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