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

Chiropractic and Pharmacy Loan Repayment Program

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists	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 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 %

	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

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.