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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[CSTLTS] Assessing Outcomes of the CDC-Harvard Program Evaluation Practicum in Building Program Evaluation Capacity in STLT Maternal and Child Health Programs (2023)
Agency IC Tracking Number:
0920-0879-23EF
IC Status:
New
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 and Instruction
None
Training Feedback from 2023 MCH Program Participants (3-Month Survey)
B- 2023 Participant 3-Month Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Training Feedback from 2023 MCH Program Participants (3-Month Survey) (screen shots)
V- 2023 Participant 3-Month Survey (Web).pdf
Yes
Yes
Fillable Fileable
Form and Instruction
None
Progress of Evaluation Implementation from 2023 CDC Harvard Practicum Participants (6-Month Survey)
C- 2023 Participant 6-Month Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Progress of Evaluation Implementation from 2023 CDC Harvard Practicum Participants (6-Month Survey) (screen shots)
W- 2023 Participant 6-Month Survey (Web).pdf
Yes
Yes
Fillable Fileable
Form and Instruction
None
Evaluation Progress and Capacity Assessment among 2023 CDC Harvard Practicum Participants (12-Month Survey)
D- 2023 Participant 12-Month Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Evaluation Progress and Capacity Assessment among 2023 CDC Harvard Practicum Participants (12-Month Survey) (screen shots)
X- 2023 Participant 12-Month Survey (Web).pdf
Yes
Yes
Fillable Fileable
Form and Instruction
None
Evaluation Progress and Capacity Building among Participants from the 2023 CDC Harvard Practicum (12-Month Interview)
E- 2023 Participant 12-Month Interview.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022) (SURVEY)
F- Former Participant Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022) (SURVEY) (screen shots)
Y- Former Participant Survey (Web).pdf
Yes
Yes
Fillable Fileable
Form and Instruction
None
Evaluation Capacity and Practicum Experience among Past Practicum Participants (2018-2022) (INTERVIEW)
G- Former Participant Interview.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
241
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 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
241
0
241
0
0
0
Annual IC Time Burden (Hours)
108
0
108
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement Part A
CSTLTS SSA_05-18-2023_clean.docx
05/18/2023
Supporting Statement Part B
CSTLTS Generic Supporting_Statement_B.docx
05/15/2023
List of Participants by Location
A- List of Participants.docx
05/15/2023
Training Feedback from 2023 CDC Harvard Practicum Participants-Advance Notification
H- 2023 Participant Advance Notification .docx
05/15/2023
Training Feedback from 2023 CDC Harvard Practicum Participants-Email with survey link
I- 2023 Participant 3-Month Survey Invitation.docx
05/15/2023
Training Feedback from 2023 CDC Harvard Practicum Participants-Reminder email
J- 2023 Participant 3-Month Survey Reminder.docx
05/15/2023
¬Progress of Evaluation Implementation from 2023 CDC Harvard Practicum Participants-Email with survey link
K- 2023 Participant 6-Month Survey Invitation.docx
05/15/2023
Progress of Evaluation Implementation from 2023 Practicum-Reminder email
L- 2023 Participant 6-Month Survey Reminder.docx
05/15/2023
Evaluation Progress and Capacity Assessment among 2023 CDC Harvard Practicum Participants-Email with survey link
M- 2023 Participant 12-Month Survey Invitation.docx
05/15/2023
Evaluation Progress and Capacity Assessment_2023 CDC Harvard Practicum Participants-Reminder email
N- 2023 Participant 12-Month Survey Reminder.docx
05/15/2023
Evaluation Progress and Capacity Building among Participants from the 2023 CDC Harvard Practicum-Interview Invitation email
O- 2023 Participant 12-Month Interview Invitation.docx
05/15/2023
Evaluation Progress and Capacity Building with Participants from the 2023 CDC Harvard Practicum- Interview Reminder email
P- 2023 Participant 12-Month Interview Reminder.docx
05/15/2023
Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022)-Advance Notification
Q- Past Participant Advance Notification.docx
05/15/2023
Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022)-Email with survey link
R- Past Participant Survey Invitation.docx
05/15/2023
Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022)-Reminder email
S- Past Participant Survey Reminder.docx
05/15/2023
Evaluation Capacity and Practicum Experience among Past Practicum Participants (2018-2022)-Interview Invitation email
T- Past Participant Interview Invitation.docx
05/15/2023
Evaluation Capacity and Practicum Experience among Past Practicum Participants (2018-2022)-Interview Reminder email
U- Past Participant Interview Reminder.docx
05/15/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.