Survey of Pharmacists

Evaluation of Phase I Demonstrations of the Pharmacy Quality Alliance

Documents and Forms

Document Name Document Type
Form Form #2 Survey of Pharmacists Form and Instruction
Form #2 Survey of Pharmacists Attachment C -- Survey of Pharmacists 10-19-2009.doc Form and Instruction
Attachment E -- Advance Letter.doc Attachment E -- Advance Letter IC Document
Attachment F -- Cover Letter.doc Attachment F -- Cover Letter IC Document
Attachment G -- Reminder Letter.doc Attachment G -- Reminder Letter IC Document

Information Collection (IC) Details

IC Title:	Survey of 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 and Instruction	Form #2	Survey of Pharmacists	Attachment C -- Survey of Pharmacists 10-19-2009.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	375	375
Annual IC Time Burden (Hours)	188	188
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment E -- Advance Letter	Attachment E -- Advance Letter.doc	05/01/2009
Attachment F -- Cover Letter	Attachment F -- Cover Letter.doc	05/01/2009
Attachment G -- Reminder Letter	Attachment G -- Reminder Letter.doc	05/01/2009

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