Information Collection

CN Operators

IC 257718 under ICR 202211-0584-012 · OMB 0584-0678.

Documents and Forms

Document Name Document Type
Appendix A- Sample State Agency Letter -1.docx Other-
Appendix A- Sample State Agency Letter -1.docx Other-
Appendix B- Nomination Form -1.docx Other-
Appendix B- Nomination Form -1.docx Other-
Appendix C- Welcome Questions -1.docx Other-
Appendix C- Welcome Questions -1.docx Other-
Appendix D- Course Evaluation -1.docx Other-
Appendix D- Course Evaluation -1.docx Other-
Appendix E- Program Impact Evaluation- 1.docx Other-
Appendix E- Program Impact Evaluation- 1.docx Other-

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CN Operators	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-	Appendix A- Sample State Agency Letter -1.docx	Yes	Yes	Fillable Printable
Other-	Appendix B- Nomination Form -1.docx	Yes	Yes	Fillable Printable
Other-	Appendix C- Welcome Questions -1.docx	Yes	Yes	Fillable Printable
Other-	Appendix D- Course Evaluation -1.docx	Yes	Yes	Fillable Printable
Other-	Appendix E- Program Impact Evaluation- 1.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 155	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	379	379
Annual IC Time Burden (Hours)	94	94
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.