Information Collection

Community and Clinical Partner Program Implementation Partner Needs Assessment

IC 203972 under ICR 201209-0920-003 · OMB 0920-0952.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0952 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Community and Clinical Partner Program Implementation Partner Needs Assessment	Form and Instruction
Com and Clinical Partners Prog Implem Partner Needs Assm Att 5 Com and Clinical Partners Prog Implem Partner Needs Assmt.Revised.docx	Form and Instruction
Att 12. Clinical Component Best Practices.docx Att 12	IC Document

IC Title:

Community and Clinical Partner Program Implementation Partner Needs Assessment

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	N/A	Com and Clinical Partners Prog Implem Partner Needs Assmt	Att 5 Com and Clinical Partners Prog Implem Partner Needs Assmt.Revised.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 12	Att 12. Clinical Component Best Practices.docx	09/04/2012

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