Survey of Title X Clinic Administrators

Evaluation of U.S. Family Planning Guidelines - Phase II

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0969 can be found here:

Documents and Forms

Document Name Document Type
Survey of Title X Clinic Administrators Form
Survey for Administrators of Publicly-funded Health Cent E1_Administrator Survey.docx Form
E2_Administrator Survey Cover Sheet.docx Att E2 - Administrator survey cover letter IC Document

Information Collection (IC) Details

IC Title:	Survey of Title X Clinic Administrators	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	none	Survey for Administrators of Publicly-funded Health Centers that Provide Family Planning Services	E1_Administrator Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	1,333	1,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att E2 - Administrator survey cover letter	E2_Administrator Survey Cover Sheet.docx	08/20/2012

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