Chiropractic and Pharmacy Loan Repayment- Survey of Clinic Medical Directors

Chiropractic and Pharmacy Loan Repayment Program

Documents and Forms

Document Name Document Type
Form Survey of Clinic M Chiropractic and Pharmacy Loan Repayment- Survey of Clinic Medical Directors Form
Survey of Clinic M Survey of Clinic Medical Directors- Pharm Tab C- MedDirs Survey-Pharm.doc Form
Survey of Clinic M Survey of Clinic Medical Directors- Chiro Tab C- Medical Directors Survey-Chiropractic.doc Form
Tab C- Cover Letter Demonstration clinics.doc Cover Letter to Medical Directors- Demo Clinics IC Document
Tab C- Cover Letter Comparison Clinics.doc Cover Letter to Medical Directors- Comparison Clinics IC Document

Information Collection (IC) Details

IC Title:	Chiropractic and Pharmacy Loan Repayment- Survey of Clinic Medical Directors	Agency IC Tracking Number:

Is this a Common Form? No		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	Survey of Clinic Medical Directors- Pharm	Survey of Clinic Medical Directors- Pharm	Tab C- MedDirs Survey-Pharm.doc		No	No	Paper Only
Form	Survey of Clinic Medical Directors - Chiro	Survey of Clinic Medical Directors- Chiro	Tab C- Medical Directors Survey-Chiropractic.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cover Letter to Medical Directors- Demo Clinics	Tab C- Cover Letter Demonstration clinics.doc	08/02/2006
Cover Letter to Medical Directors- Comparison Clinics	Tab C- Cover Letter Comparison Clinics.doc	08/02/2006

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.