OMB.report

Federal forms, ICRs, and supporting documents

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 NameDocument Type
Form Survey of Chiro Do
Survey of Chiro Doctors Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists		 Form
Form Survey of Pharmaci
Survey of Pharmacists 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

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 No No Paper Only
Form Survey of Pharmacists No No Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 30 0 30 0 0 0
Annual IC Time Burden (Hours) 15 0 15 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Cover Letter- Chiro and Pharmacists 08/02/2006
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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