OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)

ICR 201702-0920-011 · OMB 0920-0995 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0995 Short Guidelines Long-Term Evaluation Form and Instruction New Available
Form 0920-0995 Short Guidelines Post-Course Evaluation Form New Available
Form 0920-0995 STD Treatment Guidelines Complete Long-Term Evaluation Form and Instruction New Repair queued
Form 0920-0995 STD Treatment Guidelines Complete Post -Course Evaluation Form and Instruction New Available
Form 0920-0995 Wet Mount Long-Term Evaluation Form and Instruction New Available
Form 0920-0995 wet Mount Posst-Course Evaluation Form and Instruction New Available
Form 0920-0995 Practicum Long-Term Evaluation Form and Instruction New Repair queued
Form 0920-0995 Practicum Post-Course Evaluation Form and Instruction New Available
Form 0920-0995 Intensive-Didactic Long-Term Evaluation Form and Instruction New Available
Form 0920-0995 Intensive-Didactic Post Course Evaluation Form and Instruction New Available
Form 0920-0995 Intensive Complete Long-Term Evaluation Form and Instruction New Available
Form 0920-0995 Intensive Complete Post-Couse Evaluation Form and Instruction New Available
Form 0920-0995 NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT) Form and Instruction Modified Available
SupSta A.docx Supporting Statement A Uploaded 2017-02-22 Repair queued
Att 38 Table with Description of Attachments.docx Supplementary Document Uploaded 2017-02-21 Available
Att 37 Project Determination.pdf Supplementary Document Uploaded 2017-02-21 Repair queued
Att 30 Basic Post-Course Evaluation -Screenshot.pdf Supplementary Document Uploaded 2017-02-21 Available
Att 29 Basic Post-Course Evaluation wordversion.docx Supplementary Document Uploaded 2017-02-21 Available
Att 3A Previously Approved HPAT- wordversion Trackchange.docx Supplementary Document Uploaded 2017-02-21 Available
Att 3 NNPTC Abbreviated HPAT wordversion.docx Supplementary Document Uploaded 2017-02-21 Available
Att 1 Authorizing Legislation Section 301 PHSA.docx Supplementary Document Uploaded 2017-02-21 Repair queued
SupSta B.doc Supporting Statement B Uploaded 2017-02-21 Available
IC Document Collections
IC IDCollectionTypeStatusForm
225770 3 Month Long-Term Email Invitation Instruction New
225769 Immediate Post-Course Email Invitation Instruction New
225768 Basic Long-Term Evaluation Instruction New
225767 Short Guidelines Long-Term Evaluation Form and Instruction New
225766 Short Guidelines Post-Course Evaluation Form New
225765 STD Treatment Guidelines Complete Long-Term Evaluation Form and Instruction New
225764 STD Treatment Guidelines Complete Post -Course Evaluation Form and Instruction New
225763 Wet Mount Long-Term Evaluation Form and Instruction New
225762 wet Mount Posst-Course Evaluation Form and Instruction New
225748 Practicum Long-Term Evaluation Form and Instruction New
225747 Practicum Post-Course Evaluation Form and Instruction New
225745 Intensive-Didactic Long-Term Evaluation Form and Instruction New
225742 Intensive-Didactic Post Course Evaluation Form and Instruction New
225741 Intensive Complete Long-Term Evaluation Form and Instruction New
225738 Intensive Complete Post-Couse Evaluation Form and Instruction New
208451 NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT) Form and Instruction Modified
ICR Details
0920-0995 201702-0920-011
Historical Active 201309-0920-002
HHS/CDC 20457
National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 05/22/2017
Retrieve Notice of Action (NOA) 02/22/2017
  Inventory as of this Action Requested Previously Approved
05/31/2020 36 Months From Approved
7,152 0 0
423 0 0
0 0 0
The purpose of this data collection is to support program management of the National Network of Sexually Transmitted Disease Clinical Prevention Training Center (NNPTC) and to evaluate the reach and impact of the NNPTC's training activities.
PL: Pub.L. 42 - 792 776 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  81 FR 48805 07/26/2016
82 FR 9745 02/08/2017
No
16
IC Title Form No. Form Name
Practicum Post-Course Evaluation 0920-0995, 0920-0995 Att 13 Practicum Post-Course Evaluation wordversion ,   Att 14 Practicum Post-Course Evaluation -Screenshot
Practicum Long-Term Evaluation 0920-0995, 0920-0995 Att 15 Practicum Long-Term Evaluation wordversion ,   Att 16 Practicum 3-month Long-Term Evaluation -Screenshot
Intensive-Didactic Post Course Evaluation 0920-0995, 0920-0995 Att 9 Intensive Didactic Post-Course Evaluation wordversion ,   Att 10 Intensive Didactic Post-Course Evaluation – Screenshot
Intensive Complete Post-Couse Evaluation 0920-0995, 0920-0995 Att 5 Intensive Complete Post-Course Evaluation wordversion ,   Att 6 Intensive Complete Post-Course Evaluation -Screenshot
Intensive Complete Long-Term Evaluation 0920-0995, 0920-0995 Att 7 Intensive Complete Long-Term Evaluation wordversion ,   Att 8 Intensive Complete Long-Term Evaluation -Screenshot
Wet Mount Long-Term Evaluation 0920-0995, 0920-0995 Att 19 Wet Mount Long-Term wordversion ,   Att 20 Wet Mount Long Term Evaluation -Screenshot
Intensive-Didactic Long-Term Evaluation 0920-0995, 0920-0995 Att 11 Intensive Didactic Long-Term Evaluation wordversion ,   Att 12 Intensive Didactic Long-Term Evaluation -Screenshot
STD Treatment Guidelines Complete Post -Course Evaluation 0920-0995, 0920-0995 Att 22 STD Tx Guidelines Complete LongTerm Evaluation - Screenshot ,   Att 21 STD Tx Guidelines Complete Post-Course Evaluation wordversion
3 Month Long-Term Email Invitation
NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT) 0920-0995, 0920-0995 Att 3 NNPTC Abbreviated HPAT wordversion ,   Att 4 Abbreiviated HPAT Screenshot
wet Mount Posst-Course Evaluation 0920-0995, 0920-0995 Att 17 Wet Mount Post-Course Evaluation wordversion ,   Att 18 Wet Mount Post-Course Evaluation -Screenshot
STD Treatment Guidelines Complete Long-Term Evaluation 0920-0995, 0920-0995 Att 24 STD Tx Guidelines Complete Long-Term Evaluation -Screenshot ,   Att 23 STD Tx Guidelines Complete Long-Term Evaluation wordversion
Short Guidelines Post-Course Evaluation 0920-0995, 0920-0995 Att 25 STD Tx Guidelines Short Post-Course Evaluation wordversion ,   Att 26 STD Tx Guidelines Short Post-Course Evaluation -Screenshot
Short Guidelines Long-Term Evaluation 0920-0995, 0920-0995 Att 27 STD Tx Guidelines Short Long-Term Evaluation wordversion ,   Att 28 STD Tx Guidelines Short Long-Term Evaluation -Screenshot
Basic Long-Term Evaluation
Immediate Post-Course Email Invitation
  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 7,152 0 0 7,152 0 0
Annual Time Burden (Hours) 423 0 0 423 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This revision request consists of changing the title to “National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC): Evaluation” and adding 14 additional collection instruments.
$102,700
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Catina Conner 404 639-4775
  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.
02/22/2017