Clinical Directors/Supervisors Web-based Survey

Addiction Technology Transfer Centers (ATTC) National Workforce Surveys

Documents and Forms

Document Name Document Type
Form Clinical Director Clinical Directors/Supervisors Web-based Survey Form and Instruction
Attachment 2.doc Instruction
Clinical Director Clinical Director Survey Attachment 1.doc Form and Instruction
Clinical Director Clinical Director Survey Revised Attachment 1.doc Form and Instruction
Attachments4-10.pdf Attachments 4-10 IC Document

Information Collection (IC) Details

IC Title:	Clinical Directors/Supervisors Web-based Survey	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Clinical Director Survey	Clinical Director Survey	Attachment 1.doc	Yes	Yes	Paper Only
Form and Instruction	Clinical Director Survey	Clinical Director Survey Revised	Attachment 1.doc	Yes	Yes	Paper Only
Instruction			Attachment 2.doc	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 569	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	569	569
Annual IC Time Burden (Hours)	569	569
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachments 4-10	Attachments4-10.pdf	06/08/2011

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