View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Baseline Information Form
Agency IC Tracking Number:
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
Other-Information form
PHE QED Baseline Information Form_June2022_clean (1).docx
Yes
Yes
Fillable Fileable
Other-Information Form
PHE QED Baseline Information Form_Jan2023_clean_forOMB.docx
https://www.PHEvaluation.org/Enrollment
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
833
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
833
0
0
0
0
833
Annual IC Time Burden (Hours)
208
0
0
0
0
208
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Participant consent form
PHE QED Participant Consent Form_June2022_clean.docx
08/29/2022
PHE QED Baseline Information Form_Jan2023_trcks_forOMB
PHE QED Baseline Information Form_Jan2023_trcks_forOMB.docx
01/30/2023
PHE QED Participant Consent Form_Jan2023_Program_clean_forOMB
PHE QED Participant Consent Form_Jan2023_Program_clean_forOMB.docx
01/30/2023
PHE QED Participant Consent Form_Jan2023_Program_trcks_forOMB
PHE QED Participant Consent Form_Jan2023_Program_trcks_forOMB.docx
01/30/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.