Information Collection

Clinic Recruitment

IC 181191 under ICR 200707-0920-003 · OMB 0920-0759.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Clinic Recruitment	Form and Instruction
Clinic Recruitment Script Attachment C11-Clinic Recruitment Script.doc	Form and Instruction
Attachment C9-C10--Clinic Recruitment Letter & Brochure.doc Clinic Recruitment Letter and Brochure	IC Document

IC Title:

Clinic Recruitment

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 and Instruction	None	Clinic Recruitment Script	Attachment C11-Clinic Recruitment Script.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14	14
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Clinic Recruitment Letter and Brochure	Attachment C9-C10--Clinic Recruitment Letter & Brochure.doc	06/17/2007

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