Survey of non-Title X Clinic Administrators

Monitoring Changes in Attitudes and Practices among Family Planning Providers and Clinics

Documents and Forms

Document Name Document Type
Survey of non-Title X Clinic Administrators Form
Survey of Administrators of Health Centers that provide Att F-1 2018-2019 Survey for Administrators of Health Centers that Provide Family.pdf Form
Survey of Administrators of Health Centers that provide Att F-2 Screen shots of administrator survey.pdf Form

Information Collection (IC) Details

IC Title:	Survey of non-Title X Clinic Administrators	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	none	Survey of Administrators of Health Centers that provide Family Planning	Att F-1 2018-2019 Survey for Administrators of Health Centers that Provide Family.pdf		Yes	Yes	Fillable Fileable
Form	none	Survey of Administrators of Health Centers that provide Family Planning - screenshots	Att F-2 Screen shots of administrator survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	583	583
Annual IC Cost Burden (Dollars)	31,320	31,320

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.