Information Collection

Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists

IC 178407 under ICR 200701-0915-004 · OMB 0915-0306.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Survey of Chiro Do Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists	Form
Survey of Chiro Do Survey of Chiro Doctors Tab D- Chiropractor Survey Tele.doc	Form
Survey of Pharmaci Survey of Pharmacists Tab D- Pharmacist Survey.doc	Form
Appendix D Cover Letter.doc Cover Letter- Chiro and Pharmacists	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Survey of Chiro Doctors	Survey of Chiro Doctors	Tab D- Chiropractor Survey Tele.doc		No	No	Paper Only
Form	Survey of Pharmacists	Survey of Pharmacists	Tab D- Pharmacist Survey.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Letter- Chiro and Pharmacists	Appendix D Cover Letter.doc	08/02/2006

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