Community and Clinical Partner Clinical Partner Needs Assessment

Process Evaluation of "Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through Community-Wide Initiatives"

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Community and Clinical Partner Clinical Partner Needs Assessment Form and Instruction
Att 4 Clincal Partner Needs Assessment.Revised Att 4 Clincal Partner Needs Assessment.Revised.docx Form and Instruction
0920-0952 Attachment 4 (electronic) Attachment 4 (electronic).pdf Form and Instruction

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Att 4 Clincal Partner Needs Assessment.Revised	Att 4 Clincal Partner Needs Assessment.Revised.docx		No	No	Paper Only
Form and Instruction	0920-0952	Attachment 4 (electronic)	Attachment 4 (electronic).pdf		Yes	Yes	Fillable Printable

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

Percentage of Respondents Reporting Electronically: 0 %

	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

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.