Information Collection

Intervention Trials- Clinic Staff Survey

IC 190430 under ICR 200908-0915-003 · OMB 0915-0330.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Tab 3 Clinic Staff Survey Intervention Trials- Clinic Staff Survey	Form and Instruction
Tab 3 Clinic Staff Survey Tab 3 Clinic Staff Survey.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form?

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	Tab 3				Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 270

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,620	1,620
Annual IC Time Burden (Hours)	271	271
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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