Information Collection

Primary Care Faculty Development Initiative

IC 205935 under ICR 201206-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Primary Care Faculty Development Initiative	Form
1 PCFDI 3PCFDI Post Program Survey.docx	Form
OMB Supporting Statement PCFDI.docx Supporting Statement	IC Document

IC Title:

Primary Care Faculty Development Initiative

Agency IC Tracking Number:

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	1	PCFDI	3PCFDI Post Program Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

Number of Respondents for Small Entity: 36

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	36	0	0	0	0	0
Annual IC Time Burden (Hours)	6	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	OMB Supporting Statement PCFDI.docx	02/25/2013

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