Information Collection

Survey of Title X Clinic Administrators

IC 203903 under ICR 201208-0920-008 · OMB 0920-0969.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.