Trainee Survey

Rural Public Health Workforce Training Network Program (RPHWTN)

Documents and Forms

Document Name Document Type
Form 4 Trainee Survey Form
4 Trainee Survey Attachment5_RPHWTNPTraineeSurvey.pdf Form
4 Trainee Survey Attachment5_RPHWTNPTraineeSurvey_revised.pdf Form
4R Trainee Survey_Redline Attachment5_RPHWTNPTraineeSurvey_edits.docx Form

Information Collection (IC) Details

IC Title:	Trainee Survey	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	4	Trainee Survey	Attachment5_RPHWTNPTraineeSurvey_revised.pdf		Yes	Yes	Fillable Fileable
Form	4R	Trainee Survey_Redline	Attachment5_RPHWTNPTraineeSurvey_edits.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	250	250
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.