Information Collection

DDI Health Leadership Clinic Survey

IC 183709 under ICR 200802-0920-006 · OMB 0920-0791.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number DDI Health Leadership Clinic Survey	Form
No number DDI Health Leadership Clinic Survey Attachment F DDI Health Clinic Leadership Survey.doc	Form
Attachment F.3 1st and 2nd e-mail reminder messages for the clinic leadership survey.doc Attachment F	IC Document
Attachment F.1 Advance -email message to clinic leadership survey.doc Attachment F	IC Document
Attachment F.2 Cover letter for DDI Health Clinic leadership survey.doc Attachment F	IC Document
Attachment F.4 Thank you.doc Attachment F	IC Document

IC Title:

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	No number	DDI Health Leadership Clinic Survey	Attachment F DDI Health Clinic Leadership Survey.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 30

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment F	Attachment F.3 1st and 2nd e-mail reminder messages for the clinic leadership survey.doc	01/16/2008
Attachment F	Attachment F.1 Advance -email message to clinic leadership survey.doc	01/16/2008
Attachment F	Attachment F.2 Cover letter for DDI Health Clinic leadership survey.doc	01/16/2008
Attachment F	Attachment F.4 Thank you.doc	01/16/2008

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