Information Collection

Clinician survey

IC 241465 under ICR 202107-0935-004 · OMB 0935-0253.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Clinician survey	Form and Instruction
Form 3 Post-training survey to assess experiences with SHARE training: Clinician survey	Form and Instruction
Form 3 Pre-training clinician survey to assess prior experience with SDM Clinician survey	Form and Instruction
Form 3 Clinician survey to assess use of SHARE two months following training Clinician survey	Form and Instruction
3 Post-training survey to assess experiences with SHARE tr Clinician Post-survey_Clean_3.18.2020.docx	Form and Instruction
3 Post-training survey to assess experiences with SHARE tr Clinician Post-survey_Clean_3.18.2020.docx	Form and Instruction
3 Pre-training clinician survey to assess prior experience Clinician Pre-survey_Clean_3.18.2020.docx	Form and Instruction
3 Pre-training clinician survey to assess prior experience Clinician Pre-survey_Clean_3.18.2020.docx	Form and Instruction
3 Clinician survey to assess use of SHARE two months follo Clinician Pre-survey_Clean_3.18.2020.docx	Form and Instruction
3 Clinician survey to assess use of SHARE two months follo Clinician Pre-survey_Clean_3.18.2020.docx	Form and Instruction

IC Title:

Clinician survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	3	No	Fillable Fileable
Form and Instruction	3	No	Fillable Fileable
Form and Instruction	3	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
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.

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