Survey of non-Title X Clinic Providers

Monitoring Changes in Attitudes and Practices among Family Planning Providers and Clinics

OMB: 0920-0969

IC ID: 203902

Information Collection (IC) Details

View Information Collection (IC)

Survey of non-Title X Clinic Providers
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Survey of Health Care Providers D1_Provider Survey_2_25_13.pdf Yes Yes Fillable Fileable
Form none Provider Survery Screenshots Phase II Provider Web Survey Screen Shots_Revised 2012-12-18.pdf Yes Yes Fillable Fileable

Health Immunization Management

 

2,000 0
   
State, Local, and Tribal Governments
 
   20 %

  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 2,000 0 2,000 0 0 0
Annual IC Time Burden (Hours) 500 0 500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
C2 - Public-sector Cover Letter C2_Public Sector Cover Letter_02_13_13.doc 02/28/2013
D2 - Provider Survey Cover Letter D2_Provider Survey Cover Sheet_02_13_13.doc 02/28/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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