Information Collection

Community and Clinical Partner Clinical Partner Needs Assessment

IC 203971 under ICR 201309-0920-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0952 Community and Clinical Partner Clinical Partner Needs Assessment	Form and Instruction
0920-0952 Attachment 4 (electronic) Attachment 4 (electronic).pdf	Form and Instruction
Att 4 Clincal Partner Needs Assessment.Revised Att 4 Clincal Partner Needs Assessment.Revised.docx	Form and Instruction

IC Title:

Community and Clinical Partner Clinical Partner Needs Assessment

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	0920-0952	Attachment 4 (electronic)	Attachment 4 (electronic).pdf		Yes	Yes	Fillable Printable
Form and Instruction	N/A	Att 4 Clincal Partner Needs Assessment.Revised	Att 4 Clincal Partner Needs Assessment.Revised.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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