Information Collection

Survey of Pharmacists

IC 189081 under ICR 200905-0935-001 · OMB 0935-0155.

Documents and Forms

Documents and forms in this information collection
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

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 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 %

table that charts list of burden
	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

table that charts IC Documents
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.