Information Collection

Learning Collaborative Clinical - Staff Survey

IC 243374 under ICR 202008-0935-001 · OMB 0935-0258.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0258 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Learning Collaborative Clinical - Staff Survey	Form and Instruction
2 Learning Collaborative Clinical Staff Survey Attachment B_Learning Collaborative Clinical Staff Survey_05-04-2020.docx	Form and Instruction
2 Learning Collaborative Clinical Staff Survey Attachment B_Learning Collaborative Clinical Staff Survey_05-04-2020.docx	Form and Instruction

IC Title:

Learning Collaborative Clinical - Staff Survey

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Learning Collaborative Clinical Staff Survey	Attachment B_Learning Collaborative Clinical Staff Survey_05-04-2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 360

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	720	720
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

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.