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Federal forms, ICRs, and supporting documents

Information Collection

Community and Clinical Partner Program Implementation Partner Needs Assessment

IC 203972 under ICR 201409-0920-009 · OMB 0920-0952.

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

View Information Collection (IC)

Community and Clinical Partner Program Implementation Partner Needs Assessment
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction N/A Att 5 Com and Clinical Partners Prog Implem Partner Needs Assmt.Revised Att 5 Com and Clinical Partners Prog Implem Partner Needs Assmt.Revised.docx No No Paper Only
Form and Instruction 0920-0952 Attachment 5 (electronic) Attachment 5 (electronic).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

100 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 100 0 0 0 0 100
Annual IC Time Burden (Hours) 75 0 0 0 0 75
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 12 Att 12. Clinical Component Best Practices.docx 09/04/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.