Nurses Form C Shortened Survey Administered on Paper

Survey of Medical Care Providers for the Evaluation of the Regional Extension Center (REC) Program

OMB: 0955-0015

IC ID: 209871

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Document Name
Document Type
Other-survey
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Nurses Form C Shortened Survey Administered on Paper
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 20475 ID_Form C Shortened Survey Administered.docx No No Paper Only

Health Illness Prevention

 

119 0
   
Individuals or Households
 
   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 119 0 0 0 0 119
Annual IC Time Burden (Hours) 20 0 0 0 0 20
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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