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Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluation of the Domestic Violence Prevention Module at the UCLA School of Medicine

ICR 199508-0920-002 · OMB 0920-0377 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
111114 Evaluation of the Domestic Violence Prevention Module at the UCLA School of Medicine Migrated
ICR Details
0920-0377 199508-0920-002
Historical Active
HHS/CDC
Evaluation of the Domestic Violence Prevention Module at the UCLA School of Medicine
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/09/1995
Retrieve Notice of Action (NOA) 08/09/1995
  Inventory as of this Action Requested Previously Approved
08/31/1996 08/31/1996
1,380 0 0
412 0 0
0 0 0
The School of Medicine mandates routine evaluations of each of its core courses, of which the Domestic Violence is one. Besides the routine test of knowledge and skills that students receive on a regular basis, CDC proposes to have students and faculty complete process evaluation forms after two of the four sessions to assess their satisfaction with the course, as well as the implementation of it.
None
None
No
1
IC Title Form No. Form Name
Evaluation of the Domestic Violence Prevention Module at the UCLA School of Medicine
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,380 0 0 1,380 0 0
Annual Time Burden (Hours) 412 0 0 412 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/09/1995