Information Collection

RSAF - Family Program Clinician

IC 191561 under ICR 200912-0930-003 · OMB 0930-0311.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0311 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Family Program Cli RSAF - Family Program Clinician	Form and Instruction
Family Program Cli Family Program Clinician Instruments Family Program Clinician Instruments.zip	Form and Instruction

IC Title:

RSAF - Family Program Clinician

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	Family Program Clinician Instruments	Family Program Clinician Instruments	Family Program Clinician Instruments.zip		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,604	5,604
Annual IC Time Burden (Hours)	1,115	1,115
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.