Continuing Education Proposal

[PHIC] Application for Training

Documents and Forms

Document Name Document Type
Continuing Education Proposal Form
CE Proposal Att3_CE Proposal.docx Form

Information Collection (IC) Details

IC Title:	Continuing Education Proposal	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	none	CE Proposal	Att3_CE Proposal.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: 130	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	130	0	130
Annual IC Time Burden (Hours)	650	0	650
Annual IC Cost Burden (Dollars)	0	-19,955	19,955

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.