Health Center Provider Survey

Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

OMB: 0920-1156

IC ID: 222386

Information Collection (IC) Details

View Information Collection (IC)

Health Center Provider Survey
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1156 Health Center Provider Survey Online Att 4b Health Center Provider Survey Online Version.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1156 Health Center Provider Survey Att 4a Health Center Provider Survey final.docx NA Yes Yes Fillable Fileable

Health Health Care Services

 

16 0
   
State, Local, and Tribal Governments
 
   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 16 0 -8 0 0 24
Annual IC Time Burden (Hours) 6 0 -2 0 0 8
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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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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