Information Collection

Core Competencies for Amputation Rehabilitation Surveys

IC 226468 under ICR 201704-0702-001 · OMB 0702-0141.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Invitation Letter for Civilian Rehab Providers.docx	Other-Invitation Email for Civilian
Invitation Letter for DoDcontractors.docx	Other-Invitation Email for DoD Contr
Informed Consent_Civilian Rehab Provider Interviews 08.07.2017.docx	Other-Informed Consent_Civilian Reha
Informed Consent_DoD Contractor Provider Interviews.docx	Other-Informed Consent_DoD Contracto
EACE Letter of Support for RAND Interviews.pdf	Other-Recruitment Letter/Letter of S
EACE Interview protocol for DoD contractor providers 29July16.docx	Other-Interview Questions - DoD cont
EACE Interview Protocol for Civilian Rehabilitation Providers 08.07.2017.docx	Other-Interview Questions - Civilian

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Invitation Email for Civilian Rehab Providers	Yes	Yes	Fillable Fileable
Other-Invitation Email for DoD Contractors	Yes	Yes	Fillable Fileable
Other-Informed Consent_Civilian Rehab Provider	No		Paper Only
Other-Informed Consent_DoD Contractor Provider	No		Paper Only
Other-Recruitment Letter/Letter of Support	No		Paper Only
Other-Interview Questions - DoD contractor providers	No		Paper Only
Other-Interview Questions - Civilian Rehab Providers	No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	47,600	47,600

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.

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