Information Collection

Clinical Supervisor/Clinician

IC 196213 under ICR 201102-0930-002 · OMB 0930-0323.

Documents and Forms

Document Name Document Type
Form Clinical Superviso Clinical Supervisor/Clinician Form and Instruction
Clinical Superviso Clinical Supervisors Survey A2 Annual Program Survey (Clinical Supervisors Clinicians)_FINAL DRAFT_4 26 11.doc Form and Instruction
B2. All other staff emails.doc All other staff emails IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Clinical Supervisor/Clinician	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	Clinical Supervisors Survey	Clinical Supervisors Survey	A2 Annual Program Survey (Clinical Supervisors Clinicians)_FINAL DRAFT_4 26 11.doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
All other staff emails	B2. All other staff emails.doc	01/04/2011

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