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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.