OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey of Clinicians and Office Staff

IC 206889 under ICR 201305-0935-001 · OMB 0935-0212.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Survey of Clinicians and Office Staff
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Form #6 Clinician and Office Staff Survey Attachment I -- Clinician and Office Staff Survey.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

138 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 138 0 138 0 0 0
Annual IC Time Burden (Hours) 35 0 35 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment H -- Clinician and Office Staff Survey Invitation Attachment H -- Clinician and Office Staff Survey Invitation.docx 05/07/2013
Attachment H -- Clinician and Office Staff Survey Invitation Attachment H -- Clinician and Office Staff Survey Invitation.docx 05/07/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.