Information Collection

Clinic Recruitment

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.