Information Collection

Social Work and Family Physicians 6 Month Follow-Up

IC 245668 under ICR 202102-0920-003 · OMB 0920-1129.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1129 Social Work and Family Physicians 6 Month Follow-Up	Form and Instruction
0920-1129 B16 Social Work & Family Physicians Pre-Training SurveyW B16 Social Work & Family Physicians Pre-Training Survey_Web-based version.pdf	Form and Instruction
0920-1129 B16 Social Work & Family Physicians Pre-Training SurveyW B16 Social Work & Family Physicians Pre-Training Survey_Web-based version.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241

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	0920-1129	B16 Social Work & Family Physicians Pre-Training SurveyWeb-based version	B16 Social Work & Family Physicians Pre-Training Survey_Web-based version.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,167

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	1,167	1,167
Annual IC Time Burden (Hours)	156	156
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.