Information Collection

CRCC Survey

IC 185799 under ICR 200708-0925-002 · OMB 0925-0458.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0458 can be found here:

Documents and Forms

Document Name Document Type
Form 1 CRCC Survey Form
1 Survey CRCC Survey.pdf Form
OMB Generic Clearance Mini Supporting Statement_ClinicalResearhCurriculumCertificateAlumni062308 (2).doc OMB Generic Clearance Mini Supporting Statement_ClinicalResearhCurriculumCertificateAlumni062308 (2) IC Document
Generic_clearance_form_Training062308 (3).doc Generic_clearance_form_Training062308 (3) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CRCC Survey	Agency IC Tracking Number:

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	1	Survey	CRCC Survey.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	600	0	0	0	0	0
Annual IC Time Burden (Hours)	300	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Generic Clearance Mini Supporting Statement_ClinicalResearhCurriculumCertificateAlumni062308 (2)	OMB Generic Clearance Mini Supporting Statement_ClinicalResearhCurriculumCertificateAlumni062308 (2).doc	07/17/2008
Generic_clearance_form_Training062308 (3)	Generic_clearance_form_Training062308 (3).doc	07/17/2008

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