Information Collection

Clinical Supervisor/Clinician

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

Documents and Forms

Documents and forms in this information collection
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

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.