Document
Clinician Questionnaire (Form M-11C)
ICR 202112-0970-003 · OMB 0970-0564 · Object 117065701.
This document may belong to an older filing. More recent activity for OMB 0970-0564:
Document Viewer [docx]
Status: The document is viewable, but some background extraction is still pending.
Queue: Repair is queued and waiting for the next worker pass. (priority 70 · next 2026-06-19 14:34:20)
Missing: html
Download: Source copy (docx)
Loading document viewer…
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Clinician Questionnaire (Form M-11C) |
| Author | Poole, Laura (ACF) (CTR) |
| File Created | 2021-12-20 |
| Conversion State | partial |